Association between Leukoaraiosis and Symptomatic Intracranial Large Artery Stenoses and Occlusions: the Chinese Intracranial Atherosclerosis (CICAS) Study

• Type of Material: Article
• Authors: Wanying Duan, Capital Medical University; Yuehua Pu, Capital Medical University; Haiyan Liu, Capital Medical University; Jing Jing, Capital Medical University; Yuesong Pan, Capital Medical University; Xinying Zou, Capital Medical University; Yilong Wang, Capital Medical University; Xingquan Zhao, Capital Medical University; Chunxue Wang, Capital Medical University; Yongjun Wang, Capital Medical University; Ka Sing Lawrence Wong, Chinese University of Hong Kong; Ling Wei, Emory University; Liping Liu, Capital Medical University
• Language: English
• Date: 2018-12-01
• Publisher: Buck Institute for Age Research
• Publication Version: Final Published Version
• Copyright Statement: © 2018 Duan W et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.14336/AD.2018.0118
• Title of Journal or Parent Work: Aging and Disease
• ISSN: 2152-5250
• Volume: 9
• Issue: 6
• Start Page: 1074
• End Page: 1083
• Grant/Funding Information: This study was funded by the Natural Science Foundation of China (81501004), the Project of Beijing Instituted for Brain Disorders (1152130306), the Beijing Nova Plan of Science and Technology (Z161100004916104), and the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201502).
• Keywords: Science & Technology; POSTERIOR; ischemia; Life Sciences & Biomedicine; MEDULLARY INFARCTION; CEREBROVASCULAR-DISEASE; SEVERITY; ISCHEMIC-STROKE; CIRCLE; magnetic resonance imaging; WHITE-MATTER LESIONS; Geriatrics & Gerontology; leukoaraiosis; RISK; PREVALENCE; intracranial arteriosclerosis; HYPERINTENSITY
• Research Categories: Health Sciences, Epidemiology; Biology, Neuroscience

Abstract

Leukoaraiosis (LA) is frequently found in ischemic stroke patients, especially when those patients have intracranial atherosclerosis (ICAS). However, previous studies regarding an association of LA with cerebral large artery atherosclerosis showed conflicting results, and the relationship of LA with ICAS is uncertain. This study aimed to explore the association between LA and cerebral large artery atherosclerosis in Chinese patients with cerebral ischemia. Data were derived from the Chinese Intracranial Atherosclerosis (CICAS) study. Patients diagnosed with an ischemic stroke or transient ischemic attack (TIA) within 7 days of symptom onset were included. The analysis of magnetic resonance imaging (MRI) focused on severity of LA in periventricular and deep white matter; type of cerebral large artery stenosis; and the number, severity, and distribution of ICAS lesions. ICAS was defined as an occlusion or more than 50% stenosis of intracranial vessels on magnetic resonance angiography. Among 2420 patients included, distinct LA was observed in 898 (37.11%) patients, and the rate of LA increased significantly with an increased number of risk factors. Multivariate analysis revealed that LA was independently associated with ICAS (odds ratio [OR], 1.388; 95% confidence interval [CI], 1.132–1.702; P=0.0016). In the subgroup analysis of ICAS, LA was more frequently observed in multiple lesions (OR, 1.342; 95% CI, 1.060–1.699; P=0.0146), occlusive lesions (OR, 1.554; 95% CI, 1.214–1.998; P=0.0005), and lesions in the posterior circulation (OR, 1.360; 95% CI, 1.003–1.846; P=0.0481). In this nationwide prospective study, LA was associated with symptomatic ICAS, patients with multiple ICAS lesions, occlusive lesions, and atherosclerotic lesions in the posterior circulation were more likely to coexist with LA.