Correlation Between Intracranial And Extracranial Arterial Stenosis And Ischemic White Matter Lesions

ObjectiveTo study the relationship between intracranial and extracranial artery stenosis and severity of ischemic white matter lesions.Compare the difference of intracranial and extracranial artery stenosis on periventricular and subcortical white matter lesions,and analyze the independent risk factors of ischemic white matter lesions.MethodsA total of 464 patients inpatients who completed the head magnetic resonance examination and head and neck vascular examination and being hospitalized in the Department of Neurology of the First Affiliated Hospital of Chongqing Medical University from May 2017 to May 2019 were collected.Collect laboratory examinations,imaging data of brain and other relevant clinical data.The CTA / MRA / DSA were applied to assess the stenosis rate of arterial in the patient's head and neck;Cranial magnetic resonance imaging was performed to assess the location and severity of the patient's white matter lesions.The differences in the location and severityof white matter lesions in the intracranial artery group and the extracranial artery group were compared.The differences in risk factors between the subcortical white matter lesions group and the periventricular white matter lesions group were compared,and multivariate logistic regression analysis was performed.Results1.This study included a total of 464 subjects,including 275 males(59.3%)and 189 females(40.7%),with an average age of 64.4 ± 13.5 years.255 cases(55.0%)of patients with subcortical white matter lesions,147cases(31.7%)with 1 point,46 cases(9.9%)with 2 points,32 cases(6.9%)with 3 points;periventricular white matter lesions were found in 290patients(62.5%),153 patients(13.0%)with 1 point,71 patients(15.3%)with 2 points,and 42 patients(9.1%)with 3 points;214 cases(46.1%)of patients with both subcortical and periventricular white matter lesions.2.There are 58 patients(12.5%)with extracranial artery stenosis,182 patients(39.2%)with intracranial artery stenosis,and 30 patients(6.5%)with both intracranial artery and extracranial artery stenosis.254patients(54.7%)had no stenosis;45 patients(9.7%)had anterior cerebral artery stenosis,64 patients(9.2%)had middle cerebral artery stenosis,41patients(8.8%)had posterior cerebral artery stenosis,and 56 had vertebral-basilar artery stenosis Cases(12.1%).3.Compared with patients without ischemic white matter lesions,periventricular white matter lesions patients had a higher age(69.5±11.1,P<0.001)and male(140,62.2%,P=0.007)ratio,the proportion of smoking(74,32.9%,P<0.001),alcohol consumption(62,27.6%,P<0.001),coronary heart disease(15,6.7%,P<0.001),history of stroke(16,7.1%,P<0.001),and extracranial artery stenosis(125,55.6%,P<0.001)increased significantly.Compared with patients without ischemic white matter lesions,subcortical white matter lesions has a higher age(68.1±11.5,P<0.001)and male(177,61.0%,P=0.006)proportion,and the proportion of smoking(96,33.1%,P<0.001),alcohol consumption(72,24.8%,P=0.013),coronary heart disease(20,6.9%,P=0.002),history of stroke(17,5.9%,P<0.001),and extracranial artery stenosis(154,53.1%,P<0.001)increased significantly.Patients with subcortical white matter lesions had a higher proportion of diabetes(26,11.6%,P=0.022).4.Patients with intracranial artery stenosis had the highest scores of white matter lesions(periventricular white matter lesions:1.36±0.97;subcortical white matter lesions:1.62±1.11).Compared with patients without intracranial artery stenosis,the periventricular white matter lesion score(1.36±0.97)was significantly different(P=0.015),and the subcortical white matter lesion score(1.62±1.11)was not significantly different(P=0.07).The scores of periventricular white matter lesions(0.83±0.98,P=0.001)and subcortical white matter lesions(0.52±0.84,P=0.001)ofextracranial artery stenosis were significantly different from those without extracranial artery stenosis.Univariate analysis showed that intracranial arterial stenosis were associated with periventricular white matter lesions,external arterial stenosis were associated with periventricular and subcortical white matter lesions.5.Multiple-factor logistic regression was used to analyze the relationship between the types of intracranial and extracranial arterial stenosis and the severity of ischemic white matter lesions.After adjusting the history of smoking,drinking,hypertension,diabetes,coronary heart disease,hyperlipidemia,atrial fibrillation,cerebral infarction,there is a significant difference between white matter lesions and age,extracranial artery stenosis,intracranial and extracranial arterial stenosis,middle cerebral artery stenosis.ConclusionsCompared with patients without ischemic white matter lesions,patients with ischemic white matter lesions have a higher age and male proportion,and have a significantly higher proportion of smoking,drinking,coronary heart disease,stroke history,and intracranial and extracranial arterial stenosis.In this study,the proportion of patients with periventricular white matter lesions was higher than that of patients with subcortical white matter lesions.The scores of white matter lesions in patients with intracranial artery stenosis were higher than those in patientswith extracranial artery stenosis.Compared with periventricular white matter lesions,patients with subcortical white matter lesions have a higher proportion of diabetes.Intracranial and extracranial arterial stenosis,extracranial arterial stenosis,middle cerebral artery stenosis,age are independent risk factors for the ischemic white matter lesions.