The Impacts Of Middle Cerebral Artery Lesion And Collateral Circulation On Leukoaraiosis

Objective:To investigate the relationship between middle cerebral artery lesion,collateral circulation and leukoaraiosis(LA)based on the digital subtraction angiography(DSA).Method:From June 2009 to December 2012,299 patients with middle cerebral tartery lesions completed cerebral angiography admitted to the Department of Neurology,Nanjing General Hospital of Nanjing Military Command were enrolled.All patients had detailed clinical evaluation.They underwent magnetic resonance imaging evaluating LA and DSA evaluating both degree of middle cerebral artery(MCA)stenosis and collateral circulation.Adopted the Fazekas scales to evaluate the degree of LA,NASCET scale was used to ascertain the degree of MCA and ASTIN/SIR to evaluate the open of collateral circulation.Logistic regression analysis was used to test the association between MCA stenosis,collateral circulation and LA.P<0.05 was defined as significant statistical meaning.Results:Among 299 patients,males accounted for 68.6%,average age was(57±13).Patients with moderate to severe periventricular LA had older age,higher prevalence of hypertension,diabetes mellitus,hyperlipidemia,heart disease,prior stoke compared with patients without or mild periventricular LA(P<0.05).Patients with moderate to severe deep white matter LA had older age,higher prevalence of hypertension,heart disease compared with patients without or mild deep white matter LA,but the number of patients with smoking were lower than that in patients without or mild LA(P<0.05).Patients with moderate to severe periventricular LA had higher prevalence of prior LI and more numbers of LI than patients without or mild LA(P<0.05).In right deep white matter,higher prevalence of prior LI was seen in moderate to sever LA than that of without or mild LA(P<0.05);but the difference was not seen in left deep white matter(P>0.05).The degree of MCA stenosis in different degree of LA both at the periventricular and deep white matter had no significant differences(P>0.05),either the collateral circulation(P>0.05).Spearman correlation showed there were no significant relationship between collateral circulation and degree of LA both at periventricular and deep white matter,either the degree of MCA stenosis(P>0.05).Logistic regression showed that age(OR=1.107,95%CI:1.068?1.147,P<0.01),hypertension(OR=4.456,95%CI:1.612?12.318,P=0.004),prior stroke(OR=2.278,95%CI:1.150?4.513,P=0.018)and number of LI(OR=1.295,95%CI:1.005?1.668,P=0.046)were associated with left periventricular LA;age(OR=1.068,95%CI:1.032?1.105,P<0.01),hypertension(OR=4.481,95%CI:1.497-13.409,P=0.007)were associated with left deep white matter LA.Age(OR=1.097,95%CI:1.060?1.136,P<0.01),hypertension(OR=3.332,95%CI:1.301-8.529,P=0.012)and number of LI(OR=1.265,95%CI:1.037?1.544,P=0.021)were associated with right periventricular LA;age(OR=1.085,95%CI:1.046-1.126,P<0.01),hypertension(OR=3.857,95%CI:1.275-11.670,P=0.017)and number of LI(OR=1.365,95%CI:1.107?1.682,P=0.004)were associated with right deep white matter LA.Conclusions:For patients with MCA lesions,age,hypertension and number of LI were associated with periventricular LA;age,hypertension were associated with deep white matter LA.Degree of MCA stenosis and collateral circulation were not associated with LA both at periventricular and deep white matter,inferring that LA might be caused by small vessel lesions.Further larger prospective studies are needed to confirm or refute our findings.