Cerebral cortical microinfarcts in patients with internal carotid artery occlusion
Hilde van den Brink1, Doeschka A Ferro1, Jeroen de Bresser2
1Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.
Abstract:
Cerebral cortical microinfarcts (CMI) are small ischemic lesions that are associated with cognitive impairment and probably have multiple etiologies. Cerebral hypoperfusion has been proposed as a causal factor. We studied CMI in patients with internal carotid artery (ICA) occlusion, as a model for cerebral hemodynamic compromise. We included 95 patients with a complete ICA occlusion (age 66.2 ± 8.3, 22% female) and 125 reference participants (age 65.5 ± 7.4, 47% female). Participants underwent clinical, neuropsychological, and 3 T brain MRI assessment. CMI were more common in patients with an ICA occlusion (54%, median 2, range 1-33) than in the reference group (6%, median 0; range 1-7; OR 14.3; 95% CI 6.2-33.1; p<.001). CMI were more common ipsilateral to the occlusion than in the contralateral hemisphere (median 2 and 0 respectively; p<.001). In patients with CMI compared to patients without CMI, the number of additional occluded or stenosed cervical arteries was higher (p=.038), and cerebral blood flow was lower (B -6.2 ml/min/100 ml; 95% CI -12.0:-0.41; p=.036). In conclusion, CMI are common in patients with an ICA occlusion, particularly in the hemisphere of the occluded ICA. CMI burden was related to the severity of cervical arterial compromise, supporting a role of hemodynamics in CMI etiology.
Insights
Cerebral cortical microinfarcts (CMI) are significantly more common in patients with internal carotid artery (ICA) occlusion. This suggests reduced blood flow, or hemodynamics, plays a key role in their development.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Cerebral cortical microinfarcts (CMI) are small ischemic lesions linked to cognitive decline.
- Multiple factors likely contribute to CMI, with cerebral hypoperfusion being a proposed cause.
- Internal carotid artery (ICA) occlusion provides a model to study hemodynamic compromise and its effect on CMI.
Purpose of the Study:
- To investigate the prevalence and characteristics of CMI in patients with ICA occlusion.
- To assess the relationship between ICA occlusion, cerebral hemodynamics, and CMI burden.
- To explore the role of hemodynamic compromise in the etiology of CMI.
Main Methods:
- Cross-sectional study comparing 95 patients with complete ICA occlusion to 125 reference participants.
- Clinical, neuropsychological, and 3T brain MRI assessments were performed.
- CMI presence and location were evaluated, alongside data on cervical artery stenosis/occlusion and cerebral blood flow.
Main Results:
- CMI were substantially more prevalent in ICA occlusion patients (54%) versus controls (6%) (OR 14.3, p<.001).
- CMI were more frequent ipsilateral to the ICA occlusion (median 2 vs 0, p<.001).
- Patients with CMI had more cervical artery disease (p=.038) and lower cerebral blood flow (p=.036).
Conclusions:
- CMI are common in ICA occlusion, particularly on the side of the occlusion.
- The association of CMI burden with cervical arterial compromise supports a hemodynamic basis for CMI.
- These findings highlight the impact of reduced cerebral blood flow on microinfarct development.
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