Significance of increased CIMT with coexisting carotid plaques in cerebral white matter lesions in elders

Abstract

It is very common that increased carotid intima media thickness (CIMT) and carotid plaque coexist in a single subject in elderly patients with white matter lesions (WMLs). In this study we investigated whether the coexistence of increased CIMT and carotid plaque is more strongly associated with the presence and extent of WMLs than either alone. All patients were classified into 1 of the following 4 groups: without either increased CIMT (I) or carotid plaque (P): I(−)P(−); with only increased CIMT: I(+)P(−); with only carotid plaque: I(−)P(+); and with both increased CIMT and carotid plaque: I(+)P(+). The presence and severity of periventricular WMLs (PWMLs) and deep WMLs (DWMLs) were assessed and the prevalence of MRI findings by the Cochran-Armitage trend test was calculated. The characteristics of subjects showed that the percentages of patients with increased CIMT and carotid plaque in the DWMLs group and the PWMLs group were significantly higher than those without WMLs group. Both DWMLs and PWMLs were strongly associated with age, carotid plaque and CIMT. Furthermore, the Cochran-Armitage trend test indicated that the prevalence of MRI findings of PWMLs and DWMLs increased in the order of I(−)P(−)< I(+)P(−)< I(−)P(+)< I(+)P(+) (P<0.0001). For the patients with DWMLs, the grades of both I(+)P(−) and I(+)P(+) were increased significantly compared to I(−)P(−) (P<0.0025, P<0.05, respectively) without such a difference found in patients with PWMLs. Our results suggested that the coexistence of increased CIMT and carotid plaque is most closely associated with WMLs, and that increased CIMT is associated with the severity of DWMLs, whereas carotid plaque is related to the presence of WMLs.

Keywords

carotid intima media thickness / carotid plaque / deep white matter lesions / periventricular white matter lesions

References

[1] AltafN., DanielsL., MorganP.S., et al.. Cerebral white matter hyperintense lesions are associated with unstable carotid plaques. Eur J Vasc Endovasc Surg, 2006, 31(1): 8-13

[2] Ben AssayagE., Shenhar-TsarfatyS., BovaI., et al.. Asso ciation of the −757T>C polymorphism in the CRP gene with circulating C-reactive protein levels and carotid atherosclerosis. Thromb Res, 2009, 124(4): 458-462

[3] BotsM.L., van SwietenJ.C., BretelerM.M., et al.. Cerebral white matter lesions and atherosclerosis in the Rotterdam Study. Lancet, 1993, 341(8855): 1232-1237

[4] BretelerM.M., van AmerongenN.M., van SwietenJ.C., et al.. Cognitive correlates of ventricular enlargement and cerebral white matter lesions on magnetic resonance imaging. The Rotterdam Study. Stroke, 1994, 25(6): 1109-1115

[5] BretelerM.M., van SwietenJ.C., BotsM.L., et al.. Cerebral white matter lesions, vascular risk factors, and cognitive function in a population-based study: the Rotterdam Study. Neurology, 1994, 44(7): 1246-1252

[6] ClausJ.J., BretelerM.M.B., HasanD., et al.. Vascular risk factors, atherosclerosis, cerebral white matter lesions and cerebral perfusion in a population-based study. Eur J Nucl Med, 1996, 23(6): 675-682

[7] De GrootJ.C., De LeeuwF.E., OudkerkM., et al.. Cerebral white matter lesions and depressive symptoms in elderly adults. Arch Gen Psychiat, 2000, 57(11): 1071-1076

[8] De LauL.M.L., SmithA.D., RefsumH., et al.. Plasma vitamin B12 status and cerebral white-matter lesions. J Neurol Neurosur Psychiatr, 2009, 80(2): 149-157

[9] PantoniL.. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol, 2010, 9(7): 689-701

[10] Van der FlierW.M., Van StraatenE.C.W., BarkhofF., et al.. Small vessel disease and general cognitive function in nondisabled elderly: the LADIS study. Stroke, 2005, 36(10): 2116-2120

[11] Van DijkE.J., PrinsN.D., VroomanH.A., et al.. Progression of cerebral small vessel disease in relation to risk factors and cognitive consequences: Rotterdam Scan study. Stroke, 2008, 39(10): 2712-2719

[12] De LeeuwF.E., De GrootJ.C., BotsM.L., et al.. Carotid atherosclerosis and cerebral white matter lesions in a population based magnetic resonance imaging study. J Neurol, 2000, 247(4): 291-296

[13] LazarusR., PrettymanR., CherrymanG.. White matter lesions on magnetic resonance imaging and their relationship with vascular risk factors in memory clinic attenders. Int J Geriatr Psych, 2005, 20(3): 274-279

[14] SpenceJ.D.. Carotid intima-media thickness and cognitive decline: what does it mean for prevention of dementia?. J Neurol Sci, 2004, 223(2): 103-105

[15] FazekasF., ChawlukJ.B., AlaviA., et al.. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. Am J roentgenol, 1987, 149(2): 351-356

[16] PicoF., DufouilC., LevyC., et al.. Longitudinal study of carotid atherosclerosis and white matter hyperintensities: the EVA-MRI cohort. Cerebrovasc Dis, 2002, 14(2): 109-115

[17] ShresthaI., TakahashiT., NomuraE., et al.. Association between central systolic blood pressure, white matter lesions in cerebral MRI and carotid atherosclerosis. Hypertens Res, 2009, 32(10): 869-874

[18] De LeeuwF.E., De GrootJ.C., AchtenE., et al.. Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam Scan Study. J Neurol Neurosur Psychiatr, 2001, 70(1): 9-14

[19] LongstrethW.T., ManolioT.A., ArnoldA., et al.. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke, 1996, 27(8): 1274-1282

[20] KullerL.H., LongstrethW.T., ArnoldA.M., et al.. White matter hyperintensity on cranial magnetic resonance imaging: a predictor of stroke. Stroke, 2004, 35(8): 1821-1825

[21] KweeR.M., HofmanP.A.M., GronenschildE.H.B.M., et al.. Association between carotid plaque characteristics and cerebral white matter lesions: one-year follow-up study by MRI. PloS ONE, 2011, 6(2): e17070

[22] FernandoM.S., SimpsonJ.E., MatthewsF., et al.. White matter lesions in an unselected cohort of the elderly: molecular pathology suggests origin from chronic hypoperfusion injury. Stroke, 2006, 37(6): 1391-1398

[23] Ben-AssayagE., MijajlovicM., Shenhar-TsarfatyS., et al.. Leukoaraiosis is a chronic atherosclerotic disease. Sci World J, 2012, 2012: 532 141

[24] ManolioT.A., BurkeG.L., O’LearyD.H., et al.. Relationships of cerebral MRI findings to ultrasonographic carotid atherosclerosis in older adults: the Cardiovascular Health Study. CHS Collaborative Research Group. Arterioscl Throm Vas, 1999, 19(2): 356-365

[25] MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe. European Carotid Surgery Trialists’ Collaborative Group. Lancet, 1991, 337(8752): 1235-1243

[26] Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.. North American Symptomatic Carotid Endarterectomy Trial Collaborators. New Engl J Med, 1991, 325(7): 445-453

[27] SabaL., SanfilippoR., PascalisL., et al.. Carotid artery abnormalities and leukoaraiosis in elderly patients: evaluation with MDCT. Am J Roentgenol, 2009, 192(2): W63-W70

[28] ReadS.J., PettigrewL., SchimmelL., et al.. White matter medullary infarcts: acute subcortical infarction in the centrum ovale. Cerebrovasc Dis, 1998, 8(5): 289-295

[29] OhmineT., MiwaY., YaoH., et al.. Association between arterial stiffness and cerebral white matter lesions in community-dwelling elderly subjects. Hypertens Res, 2008, 31(1): 75-81

[30] KimK.W., MacFallJ.R., PayneM.E.. Classification of white matter lesions on magnetic resonance imaging in elderly persons. Biol Psychiat, 2008, 64(4): 273-280

[31] FazekasF., KleinertR., OffenbacherH., et al.. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology, 1993, 43(9): 1683-1689

[32] SimpsonJ.E., InceP.G., HighamC.E., et al.. Microglial activation in white matter lesions and nonlesional white matter of ageing brains. Neuropath Appl Neuro, 2007, 33(6): 670-683

[33] PrinsN.D., Van DijkE.J., Den HeijerT., et al.. Cerebral white matter lesions and the risk of dementia. Arch Neurol, 2004, 61(10): 1531-1534

[34] PietersB., StaalsJ., KnottnerusI., et al.. Periventricular white matter lucencies relate to low vitamin B12 levels in patients with small vessel stroke. Stroke, 2009, 40(5): 1623-1626