Carotid Atheroinflammation Is Associated With Cerebral Small Vessel Disease Severity.

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Evans, Nicholas R 
Tarkin, Jason M 
Walsh, Jessica 
Chowdhury, Mohammed M 
Patterson, Andrew J 

Background: Atherosclerosis is a systemic inflammatory disease, with common inflammatory processes implicated in both atheroma vulnerability and blood-brain barrier disruption. This prospective multimodal imaging study aimed to measure directly the association between systemic atheroma inflammation ("atheroinflammation") and downstream chronic cerebral small vessel disease severity. Methods: Twenty-six individuals with ischemic stroke with ipsilateral carotid artery stenosis of >50% underwent 18fluoride-fluorodeoxyglucose-positron emission tomography within 2 weeks of stroke. Small vessel disease severity and white matter hyperintensity volume were assessed using 3-tesla magnetic resonance imaging also within 2 weeks of stroke. Results: Fluorodeoxyglucose uptake was independently associated with more severe small vessel disease (odds ratio 6.18, 95% confidence interval 2.1-18.2, P < 0.01 for the non-culprit carotid artery) and larger white matter hyperintensity volumes (coefficient = 14.33 mL, P < 0.01 for the non-culprit carotid artery). Conclusion: These proof-of-concept results have important implications for our understanding of the neurovascular interface and potential therapeutic exploitation in the management of systemic atherosclerosis, particularly non-stenotic disease previously considered asymptomatic, in order to reduce the burden of chronic cerebrovascular disease.

atherosclerosis, blood-brain barrier, carotid artery, carotid-cerebrovascular interface, cerebrovascular disease/stroke, leukoaraiosis
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Front Neurol
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Frontiers Media SA
The Dunhill Medical Trust (None)
Wellcome Trust (211100/Z/18/Z)
British Heart Foundation (FS/16/29/31957)