Brain Changes in the White Matter of the Brain White Matter Changes and Cognitive Functions in Asymptomatic Patients

Impact of shaggy aorta on intraoperative cerebral embolism during carotid artery stenting

BACKGROUND

Careful selection of patients for carotid stenting is necessary. We suggest that patients with a shaggy aorta syndrome may be at higher risk for perioperative embolic complications.

METHODS

The study is a retrospective subanalysis of the SIBERIA Trial. We included 72 patients undergoing transfemoral carotid artery stenting. Patients were monitored during the procedures using multifrequency transcranial Doppler with embolus detection and differentiation. Pre- and postprocedural (2 and 30 days) cerebral diffusion-weighted cerebral MRIs were performed.

RESULTS

Forty-six patients had shaggy aorta syndrome. Intraoperative embolisms were recorded in 82.6% and 46.1% of patients with and without shaggy aorta syndrome, respectively (P=0.001). New asymptomatic ischemic brain lesions in the postoperative period occurred in 78.3% and in 26.9% of patients with and without shaggy aorta syndrome, respectively (P<0.001). There were no cases of stroke within 2 days in both groups. 3 (6.5%) cases of stroke within 30 days after the procedure were observed only in patients with shaggy aorta syndrome. There were no cases of contralateral stroke. Shaggy aorta syndrome (OR 5.54 [1.83:16.7], P=0.001) and aortic arch ulceration (OR 6.67 [1.19: 37.3], P=0.02) were independently associated with cerebral embolism. Shaggy aorta syndrome (OR 9.77 [3.14-30.37], P<0.001) and aortic arch ulceration (OR 12.9 [2.3: 72.8], P=0.003) were independently associated with ipsilateral new asymptomatic ischemic brain lesions.

CONCLUSIONS

Shaggy aorta syndrome and aortic arch ulceration significantly increase the odds of intraoperative embolism and new asymptomatic ischemic brain lesions. Carotid endarterectomy or transcervical carotid stent should be selected in patients with shaggy aorta syndrome.

State of intra- and extracranial arteries, white matter and cerebral cortex in asymptomatic hypertensive patients

Aim. To assess the state of intra- and extracranial arteries, white matter and cerebral cortex in asymptomatic hypertensive (HTN) patients according to multimodal examination.

Material and methods. The study included data from 147 asymptomatic individuals (without prior ischemic stroke) with an established HTN (n=43; 29,3%) and without it. All participants underwent extracranial duplex ultrasound, transcranial duplex sonography, detection of middle cerebral artery microembolism, and brain magnetic resonance imaging. We performed a statistical analysis of the data obtained, adjusted for age and body mass index.

Results. In patients with HTN, atherosclerotic plaques were more often detected — 37,2 vs 14,4% on the right (p=0,027) and 41,9 vs 13,5% on the left (p=0,001). In these patients, intima-media abnormalities and common carotid artery narrowing were also more common. Regional temporal lobe atrophy (p=0,044 on the right and p=0,046 on the left), central atrophy (p=0,045), focal periventricular white matter abnormalities (p=0,004) were more pronounced in hypertensive patients. There was no association between HTN and the presence of cerebral microbleeds, as well as the Montreal Cognitive Assessment (MoCA) score.

Conclusion. In asymptomatic hypertensive patients relative to those without HTN, with comparable body mass index and age, head arterial abnormalities are more pronounced, but this regards only large ones — the common carotid artery. In these patients, more pronounced white matter and cerebral cortex changes were revealed.

Interrelations of Cerebral Hemodynamics with Parameters of Cardiac Function and Brain Tissue in Patients with Ischemic Stroke

We analyzed interrelations between the cerebral blood flow, cardiac output, and condition of the brain substance in 530 patients with ischemic stroke. Dependencies between the linear blood flow velocities in all arteries supplying the brain, as well as between the total volume blood flow through the internal carotid arteries and left ventricular stroke volume were revealed. The severity of atrophy was maximum in the parietal lobes (median 1.5 (1.0; 2.0)) and minimum in the occipital lobes (median 0.5 (0; 1.0)). Temporal lobes cortical atrophy significantly correlated with changes in the limbic system and in the periventricular and deep white matter; a significant weak inverse correlation of this parameter with blood flow in the middle cerebral artery was also found. Changes in the periventricular white matter (but not in deep white matter) demonstrated a significant inverse correlation with blood flow in the middle and anterior cerebral arteries.