Correlation Between Leukoaraiosis And Intracranial And Extracranial Artery Stenosis

Background:With the aging of the population,the incidence of leukoaraiosis in the elderly population is gradually increasing.The diagnosis and treatment of leukoaraiosis and secondary prevention are increasingly attracting the attention of clinicians.Previous studies have suggested that leukoaraiosis is associated with atherosclerotic stenosis of large arteries,but there are also some controversies.These studies mostly use cervical vascular ultrasound,CTA(CT angiography)or MRA(Magnetic Resonance Angiography)to evaluate the blood vessels,and have certain limitations.Objective: According to the basic clinical characteristics of the patients,we explored the potential risk factors for leukoaraiosis.In this study,DSA(digital substraction angiography)was used to evaluate the stenosis of the intracranial or extracranial large artery,and then to investigate the correlation between white matter quality and intracranial and extracranial aortic stenosis.Methods: This study used retrospective research methods,collected patient data in strict accordance with certain inclusion criteria and exclusion criteria,and included a total of 110 patients with ischemic cerebrovascular disease admitted to The Affiliated Hospital of Qingdao University.All patients underwent magnetic resonance imaging(MRI)and DSA.At the same time,the patient's age,gender,smoking history,drinking history,hypertension,diabetes,and biochemical tests on the second day of admission were collected,including(fasting blood glucose,glycated albumin,triglycerides,cholesterol,high-density lipoprotein,low-density lipoprotein).).Assessment of vascular stenosis: including the internal carotid artery,vertebral artery,basilar artery,anterior cerebral artery,middle cerebral artery,posterior cerebral artery,the diagnostic criteria of stenosis degree according to the criteria of NASCET(North American Symptomatic Carotid Endarterectomy Trial): 1 normal;2 mild stenosis(1-49%);3 moderate stenosis(50-69%);4 severe stenosis(70-99%);5 occlusion.Assessment of leukoaraiosis: According to the T2 Flair image assessment of lesions,LA was graded strictly according to the Fazekas score(level 0-3).SPSS22.0 software was used for statistical analysis.Categorical data between two groups were analyzed with ?~2 test.Continuous values were expressed as mean ± SD.Normally distributed data were analyzed with t-test.Variance analysis and Mann-Whitney U test were used to compare data between multiple groups(grade data).The logistic regression method was used for the multivariate analysis.Spearman correlation was performed to assess the correlation between the severity of leukoaraiosis and large artery stenosis.Results: Univariate analysis showed that age(?~2=4.746 P<0.001),hypertension(?~2=0.023 P=0.023),and carotid artery stenosis(?~2=11.594 P= 0.001),multi-vessel stenosis(?~2=0.002 P=0.002),the differences between the groups were statistically significant.Graded data One-way ANOVA revealed that older age(F=9.421 P<0.001)may increase the risk of LA;Mann-Whitney U test results show that the frequency of different grades of LA occurs in both hypertensive and non-hypertensive patients(Z=-2.275 P=0.023).Statistical significance was based on P<0.05.Logistic regression analysis showed that old age(OR=1.14 95% CI=1.06~1.22 P<0.001)and hypertension(OR=5.21 95%CI=1.13~24.04 P=0.034)and multiple vascular stenosis(OR=46.31 95%CI=5.67 to 378.44 P<0.001)were correlated with the severity of leukoaraiosis.A positive correlation was found between the severity of the leukoaraiosis and the degree of carotid artery stenosis(Left carotid artery r=0.239 P=0.012;Right carotid artery r=0.253 P=0.008).Also,LA was positively correlated with posterior circulation artery stenosis(Right vertebrae r=0.222 P=0.020;Basilar artery r=0.190 P=0.046).No apparent correlation exists between the presence and severity of leukoaraiosis and middle cerebral artery,anterior cerebral artery,posterior cerebral artery.Conclusions: Old age and hypertension are independent risk factors for leukoaraiosis.The severity of leukoaraiosis is positively correlated with the severity of intracranial and extracranial aortic stenosis(carotid artery and vertebrobasilar artery),suggesting that we should pay attention to the screening of large artery disease in patients with leukoaraiosis,in order to have a a better prognosis for the patient.