Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis
Background and Purpose High-grade carotid artery stenosis may alter hemodynamics in the ipsilateral hemisphere, but consequences of this effect are poorly understood. Cortical thinning is associated with cognitive impairment in dementia, head trauma, demyelination, and stroke. We hypothesized that h...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Stroke Society
2023-01-01
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| Series: | Journal of Stroke |
| Subjects: | |
| Online Access: | http://www.j-stroke.org/upload/pdf/jos-2022-02285.pdf |
| _version_ | 1811171019934662656 |
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| author | Randolph S. Marshall David S. Liebeskind John Huston III Lloyd J. Edwards George Howard James F. Meschia Thomas G. Brott Brajesh K. Lal Donald Heck Giuseppe Lanzino Navdeep Sangha Vikram S. Kashyap Clarissa D. Morales Dejania Cotton-Samuel Andres M. Rivera Adam M. Brickman Ronald M. Lazar |
| author_facet | Randolph S. Marshall David S. Liebeskind John Huston III Lloyd J. Edwards George Howard James F. Meschia Thomas G. Brott Brajesh K. Lal Donald Heck Giuseppe Lanzino Navdeep Sangha Vikram S. Kashyap Clarissa D. Morales Dejania Cotton-Samuel Andres M. Rivera Adam M. Brickman Ronald M. Lazar |
| author_sort | Randolph S. Marshall |
| collection | DOAJ |
| description | Background and Purpose High-grade carotid artery stenosis may alter hemodynamics in the ipsilateral hemisphere, but consequences of this effect are poorly understood. Cortical thinning is associated with cognitive impairment in dementia, head trauma, demyelination, and stroke. We hypothesized that hemodynamic impairment, as represented by a relative time-to-peak (TTP) delay on MRI in the hemisphere ipsilateral to the stenosis, would be associated with relative cortical thinning in that hemisphere. Methods We used baseline MRI data from the NINDS-funded Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis–Hemodynamics (CREST-H) study. Dynamic contrast susceptibility MR perfusion-weighted images were post-processed with quantitative perfusion maps using deconvolution of tissue and arterial signals. The protocol derived a hemispheric TTP delay, calculated by subtraction of voxel values in the hemisphere ipsilateral minus those contralateral to the stenosis. Results Among 110 consecutive patients enrolled in CREST-H to date, 45 (41%) had TTP delay of at least 0.5 seconds and 9 (8.3%) subjects had TTP delay of at least 2.0 seconds, the maximum delay measured. For every 0.25-second increase in TTP delay above 0.5 seconds, there was a 0.006-mm (6 micron) increase in cortical thickness asymmetry. Across the range of hemodynamic impairment, TTP delay independently predicted relative cortical thinning on the side of stenosis, adjusting for age, sex, hypertension, hemisphere, smoking history, low-density lipoprotein cholesterol, and preexisting infarction (P=0.032). Conclusions Our findings suggest that hemodynamic impairment from high-grade asymptomatic carotid stenosis may structurally alter the cortex supplied by the stenotic carotid artery. |
| first_indexed | 2024-04-10T17:06:32Z |
| format | Article |
| id | doaj.art-b33a939386444fd8b5d75d9ccd336f18 |
| institution | Directory Open Access Journal |
| issn | 2287-6391 2287-6405 |
| language | English |
| last_indexed | 2024-04-10T17:06:32Z |
| publishDate | 2023-01-01 |
| publisher | Korean Stroke Society |
| record_format | Article |
| series | Journal of Stroke |
| spelling | doaj.art-b33a939386444fd8b5d75d9ccd336f182023-02-06T04:21:23ZengKorean Stroke SocietyJournal of Stroke2287-63912287-64052023-01-012519210010.5853/jos.2022.02285460Cortical Thinning in High-Grade Asymptomatic Carotid StenosisRandolph S. Marshall0David S. Liebeskind1John Huston III2Lloyd J. Edwards3George Howard4James F. Meschia5Thomas G. Brott6Brajesh K. Lal7Donald Heck8Giuseppe Lanzino9Navdeep Sangha10Vikram S. Kashyap11Clarissa D. Morales12Dejania Cotton-Samuel13Andres M. Rivera14Adam M. Brickman15Ronald M. Lazar16 Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA Department of Radiology, Mayo Clinic, Rochester, MN, USA Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA Department of Neurology, Mayo Clinic, Jacksonville, FL, USA Department of Neurology, Mayo Clinic, Jacksonville, FL, USA Department of Surgery, University of Maryland, Baltimore, MD, USA Department of Radiology, Novant Health Clinical Research, Winston-Salem, NC, USA Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA Department of Neurology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USABackground and Purpose High-grade carotid artery stenosis may alter hemodynamics in the ipsilateral hemisphere, but consequences of this effect are poorly understood. Cortical thinning is associated with cognitive impairment in dementia, head trauma, demyelination, and stroke. We hypothesized that hemodynamic impairment, as represented by a relative time-to-peak (TTP) delay on MRI in the hemisphere ipsilateral to the stenosis, would be associated with relative cortical thinning in that hemisphere. Methods We used baseline MRI data from the NINDS-funded Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis–Hemodynamics (CREST-H) study. Dynamic contrast susceptibility MR perfusion-weighted images were post-processed with quantitative perfusion maps using deconvolution of tissue and arterial signals. The protocol derived a hemispheric TTP delay, calculated by subtraction of voxel values in the hemisphere ipsilateral minus those contralateral to the stenosis. Results Among 110 consecutive patients enrolled in CREST-H to date, 45 (41%) had TTP delay of at least 0.5 seconds and 9 (8.3%) subjects had TTP delay of at least 2.0 seconds, the maximum delay measured. For every 0.25-second increase in TTP delay above 0.5 seconds, there was a 0.006-mm (6 micron) increase in cortical thickness asymmetry. Across the range of hemodynamic impairment, TTP delay independently predicted relative cortical thinning on the side of stenosis, adjusting for age, sex, hypertension, hemisphere, smoking history, low-density lipoprotein cholesterol, and preexisting infarction (P=0.032). Conclusions Our findings suggest that hemodynamic impairment from high-grade asymptomatic carotid stenosis may structurally alter the cortex supplied by the stenotic carotid artery.http://www.j-stroke.org/upload/pdf/jos-2022-02285.pdfcarotid stenosiscerebral blood flowcognitionbrain cortical thicknessperfusion weighted mri |
| spellingShingle | Randolph S. Marshall David S. Liebeskind John Huston III Lloyd J. Edwards George Howard James F. Meschia Thomas G. Brott Brajesh K. Lal Donald Heck Giuseppe Lanzino Navdeep Sangha Vikram S. Kashyap Clarissa D. Morales Dejania Cotton-Samuel Andres M. Rivera Adam M. Brickman Ronald M. Lazar Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis Journal of Stroke carotid stenosis cerebral blood flow cognition brain cortical thickness perfusion weighted mri |
| title | Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis |
| title_full | Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis |
| title_fullStr | Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis |
| title_full_unstemmed | Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis |
| title_short | Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis |
| title_sort | cortical thinning in high grade asymptomatic carotid stenosis |
| topic | carotid stenosis cerebral blood flow cognition brain cortical thickness perfusion weighted mri |
| url | http://www.j-stroke.org/upload/pdf/jos-2022-02285.pdf |
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