Related Experiment Video
Updated: Mar 27, 2026
Fundus Photography as a Convenient Tool to Study Microvascular Responses to Cardiovascular Disease Risk Factors in Epidemiological Studies
Published on: October 22, 2014
Brain microangiopathy and macroangiopathy share common risk factors and biomarkers
Oh Young Bang1, Jong-Won Chung1, Sookyung Ryoo1
1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Aims:
Besides carotid or cardiac embolism, stroke can occur via microangiopathy (small arterial disease [SAD]) and macroangiopathy (intracranial atherosclerotic stroke [ICAS]) of the intracranial vasculature. There have been efforts to identify risk factors specific to microangiopathy and macroangiopathy, including vascular risk factors, and protein and genetic biomarkers. We hypothesized that despite the anatomic and pathophysiological differences between microvessels and macrovessels, microangiopathy and macroangiopathy share common risk factors during disease progression.
Methods:
Among 714 patients with acute infarctions within middle cerebral artery territory, 126 with SAD and 116 with ICAS were included in this study. Subclinical microangiopathy (degree of leukoaraiosis) and macroangiopathy (number of tandem stenosis) was graded in each patient. Inflammatory biomarkers (C-reactive protein, E-selectin, and LpPLA2), endothelial dysfunction (asymmetric dimethylarginine, urinary albumin-to-creatinine ratio, endostatin, and homocysteine), atherogenesis (lipoprotein(a), adiponectin, and resistin), and renal function (creatinine clearance and estimated glomerular filtration rate) were assessed.
Results:
Compared with the patients with isolated SAD, those with isolated ICAS were younger, were current smokers, and showed higher apoB levels (p < 0.05 in all cases). However, with the progression of subclinical microangiopathy, asymptomatic macroangiopathy worsened and vice versa. No significant differences in risk factors were observed between advanced SAD and ICAS. Decreased renal function was independently associated with progression of microangiopathy and macroangiopathy. Markers of endothelial dysfunction, but not the other markers, were significantly related to creatinine clearance level.
Conclusions:
Mild to moderate loss of renal function is strongly associated with both intracranial microangiopathy and macroangiopathy. Endothelial dysfunction may be associated with this relationship.
Insights
Mild to moderate kidney dysfunction is linked to both small arterial disease and intracranial atherosclerotic stroke. Endothelial dysfunction may play a role in this association, impacting cerebrovascular health.
Area of Science:
- Neurology
- Vascular Biology
- Nephrology
Background:
- Stroke can result from small arterial disease (SAD) or intracranial atherosclerotic stroke (ICAS), distinct from embolic causes.
- Identifying shared risk factors for microangiopathy and macroangiopathy is crucial for understanding stroke progression.
- Previous research has focused on specific risk factors for each type of intracranial vascular disease.
Purpose of the Study:
- To investigate shared risk factors between small arterial disease (SAD) and intracranial atherosclerotic stroke (ICAS).
- To determine the association between renal function, endothelial dysfunction, and these intracranial vascular pathologies.
- To test the hypothesis that microangiopathy and macroangiopathy share common risk factors.
Main Methods:
- Assessed 126 patients with SAD and 116 with ICAS among 714 patients with middle cerebral artery territory infarctions.
- Quantified subclinical microangiopathy (leukoaraiosis) and macroangiopathy (tandem stenosis).
- Measured inflammatory biomarkers, endothelial dysfunction markers, atherogenesis markers, and renal function.
Main Results:
- No significant differences in risk factors were found between advanced SAD and ICAS.
- Decreased renal function was independently associated with the progression of both microangiopathy and macroangiopathy.
- Markers of endothelial dysfunction were significantly related to creatinine clearance levels.
Conclusions:
- Mild to moderate renal function loss is strongly associated with both intracranial microangiopathy and macroangiopathy.
- Endothelial dysfunction may be implicated in the relationship between renal function and intracranial vascular diseases.
- Shared risk factors, particularly renal function, are important in the progression of cerebrovascular diseases.
