Correlation Between Inttracranial Large Artery Stenosis And Subtypes Of Small Cerebral Vascular Diease And Cognition

Part I: Correlation between intracranial large artery stenosis and subtypes of cerebral small vessel diseaseObjective: To study the correlation between intracranial large artery stenosis and subtypes of Cerebral small vessel disease(CSVD),and offer insight into the prevention and treatment of CSVD.Methods: CSVD patients hospitalized in the Department of Neurology,Hebei General Hospital from January 2019 to September2022 were enrolled.Besides serological examination and Magnetic resonance imaging(MRI),all subjects received high resolution magnetic resonance vessel wall imaging(HRMR-VWI)or computed tomography angiography(CTA)to assess the degree of intracranial artery stenosis.The subjects were divided into groups according to their subtypes of CSVD to explore the related risk factors,and then the correlation between the severity of different subtypes of CSVD and intracranial large artery stenosis was studied.SPSS26.0 was used for data analysis.The correlation between intracranial large artery stenosis and CSVD subtypes were analyzed by two independent sample t test,non-parametric test,χ~2 test,rank sum test,multivariate logistic regression and Spearman correlation analysis.Results:1.Univariate analysis showed statistically significant differences in age,gender,smoking history,coronary heart disease history,UA,Cr levels,and MCA stenosis degree between the WMH group and non-WMH group(P<0.05).There were significant differences in age,total bilirubin level,and the degree of MCA and PCA stenosis between the LI group and the non-LI group(P<0.05).There were significant differences in age,history of hypertension,systolic blood pressure,diastolic blood pressure and degree of MCA stenosis between the CMBs group and the non-CMBs group(P<0.05).There were significant differences in age,Hcy level and PCA stenosis degree between the EPVS group and the non-EPVS group(P<0.05).2.According to the results of univariate analysis,variables with P<0.05 were included in the multifactorial logistic regression analysis,and the results showed age(OR=1.173,95%CI:1.114～1.235,P<0.001)and MCA stenosis(OR=0.334,95%CI: 0.139～0.807,P=0.015)were WMH’s independent risk factors.Age(OR=1.117,95%CI: 1.071～1.166,P<0.001)and MCA stenosis(OR=0.344,95%CI: 0.133～0.887,P=0.027)were independent risk factors for LI.Age(OR=1.047,95%CI: 1.016～1.079,P=0.003),history of hypertension(OR=2.114,95%CI: 1.099～4.066,P=0.025),diastolic blood pressure level(OR=1.034,95%CI:1.005-1.064,P=0.02),MCA stenosis(OR=0.223,95% CI: 0.096-0.519,P<0.001)were independent risk factors for CMBs.Age(OR =1.073,95%CI: 1.039～1.109,P<0.001)was an independent risk factor for EPVS.3.According to the results of univariate analysis,variables with P<0.05 were included in the Spearman correlation analysis revealed that WMH grading was positively correlated with MCA(r=0.418,P<0.001)stenosis.LI grading was positively correlated with MCA(r=0.422,P<0.001)and PCA(r=0.310,P<0.001)stenosis.CMBs grading was positively correlated with MCA(r=0.316,P<0.001)stenosis.EPVS grading was positively correlated with PCA(r=0.264,P<0.001)stenosis.Conclusions : 1.Risk factors differed among CSVD subtypes,suggesting that the pathogenesis of different subtypes of CSVD may be different.2.WMH grading and CMBs grading were positively correlated with MCA stenosis;LI grading was positively correlated with MCA and PCA stenosis;EPVS grading was positively correlated with PCA stenosis.Part II: Correlation between intracranial large artery stenosis and cognition in patients with CSVDObjective: To evaluate the correlation between intracranial large artery stenosis and cognition in patients with CSVD,and to provide ideas for the prevention and treatment of cognitive impairment related to intracranial large artery stenosis in patients with CSVD.Methods: Forty-five CSVD patients who completed the Montreal cognitive assessment(Mo CA)test in the first part were selected.According to the Mo CA total score of 26,they were divided into cognitive impairment group(≤26 points)and normal cognitive function group(>26 points).χ~2 test was used to compare intracranial large artery stenosis Whether or not differences between the normal cognitive function group and the impaired cognitive function group.Spearman correlation analysis was used to analyze the correlation between the degree of MCA and PCA stenosis and the total score of Mo CA and different cognitive domain.Results:1.There were significant differences in the degree of MCA(P=0.001)and PCA(P=0.035)stenosis between the normal cognitive function group and the impaired cognitive function group.2.Spearman correlation analysis showed that the degree of MCA stenosis was negatively correlated the total MOCA score(r=-0.467,P=0.001),visuospatial(r=-0.566,P<0.001),attention(r=-0.409,P=0.005),language(r=-0.396,P=0.007),abstraction(r=-0.365,P=0.014),and orientation(r=-0.383,P=0.009);,and PCA stenosis was negatively correlated with naming(r=-0.317,P= 0.034)and delayed recall(r=-0.328,P=0.028).Conclusions:Cognitive function was associated with intracranial arterial stenosis.The degree of MCA stenosis was negatively correlated with the total score of MOCA,visuospatial,attention,language,abstraction and orientation scores,and the degree of PCA stenosis was negatively correlated with naming and delayed recall scores.