Association between Intracerebral Artery Stenosis and Cortical Infarcts, Lacunes, White Matter Hyperintensities and...

Introduction: Intracranial artery stenosis (ICAS) is a significant contributor to cortical infarcts, and studies have also shown associations between ICAS and structural brain changes, such as lacunes, white matter hyperintensities (WMHs), and brain atrophy. We aimed to assess the associations between ICAS and cortical infarcts, lacunes, WMHs, and brain parenchymal fraction (BPF) in a general population.

We included 1,842 participants (981 women and 861 men) aged 40-84 years who participated in a cross-sectional population-based study. Three-dimensional time-of-flight magnetic resonance angiography was used for the assessment of ICAS, while 3D T2-fluid-attenuated inversion recovery sequences, 3D T1-weighted sequences, and susceptibility-weighted images were used for evaluation of brain structure. ICAS was defined as a ≥50% focal narrowing of the intracranial arterial flow diameter. WMHs were assessed by the Fazekas score and automated volumetric measurements. BPF was used as a proxy for brain atrophy.

The 111 participants (6.0%) with ICAS had significantly more cortical infarcts (23.4% vs. 5.5%, p < 0.001) and lacunes (27.0% vs. 7.7%, p < 0.001) compared to participants without ICAS (1,731). Multivariable-adjusted analysis showed an independent association between ICAS and cortical infarcts (OR: 2.23, 95% CI: 1.27 to 3.90, p = 0.005) and lacunes (OR 2.05, 95% CI: 1.24 to 3.41, p = 0.005), mainly driven by lacunes in the posterior circulation (OR: 4.76, 95% CI: 1.75 to 12.97, p = 0.002). ICAS was independently associated with moderate-to-severe periventricular Fazekas score (OR 2.04, 95% CI: 1.26 to 3.28) and BPF (β-coefficient -0.0131, 95% CI: -0.0232 to -0.0030). There was no significant association between ICAS and deep moderate-to-severe Fazekas score or WMH volumes.

ICAS was associated with both cortical infarcts in the anterior and posterior circulation and with lacunes in the posterior circulation. The results also indicate a relationship between ICAS and periventricular WMHs and brain atrophy.