Effect of carotid artery stenosis on cortical microinfarcts, white matter integrity, and brain volume: An interhemispheric comparison within the population-based Rotterdam Study

Background: Carotid artery stenosis could contribute to gradual loss of brain function through chronic hypoxia and ischemia. Methods: We included consecutive participants of the population-based Rotterdam Study with unilateral ≥50 % stenosis at the carotid artery bifurcation on time-of-flight caroti...

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Main Authors: Frank J. Wolters, Meike W. Vernooij, Gennady V. Roshchupkin, M․Arfan Ikram, Maryam Kavousi, Peter J. Koudstaal, Aad van der Lugt, Daniel Bos
Format: Article
Language:English
Published: Elsevier 2025-01-01
Series:Cerebral Circulation - Cognition and Behavior
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Online Access:http://www.sciencedirect.com/science/article/pii/S2666245025000157
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author Frank J. Wolters
Meike W. Vernooij
Gennady V. Roshchupkin
M․Arfan Ikram
Maryam Kavousi
Peter J. Koudstaal
Aad van der Lugt
Daniel Bos
author_facet Frank J. Wolters
Meike W. Vernooij
Gennady V. Roshchupkin
M․Arfan Ikram
Maryam Kavousi
Peter J. Koudstaal
Aad van der Lugt
Daniel Bos
author_sort Frank J. Wolters
collection DOAJ
description Background: Carotid artery stenosis could contribute to gradual loss of brain function through chronic hypoxia and ischemia. Methods: We included consecutive participants of the population-based Rotterdam Study with unilateral ≥50 % stenosis at the carotid artery bifurcation on time-of-flight carotid MR angiography, and compared between hemispheres the presence of ischemic lesions, tissue volumes, and white matter integrity on structural brain MRI. Results: Among 50 participants (mean age 76 years, 50 % women), flow was lower in the affected carotid artery than on the unaffected side (160mL/min versus 202mL/min; flow reduction [95 %CI] per 1 % increase in stenosis: 1.7 mL/min [1.0–2.5]). Twelve individuals had radiographic evidence of cortical infarction, of whom 8 had cortical microinfarcts, all on the side of the stenosis (P = 0.001). Downstream of the stenotic artery, parenchymal volume was lower than in the contralateral hemisphere (mean difference: -2.7 mL [-4.9;-0.4]), similar for grey and white matter. Differences were most profound in the frontoparietal lobes, and increased with severity of stenosis to roughly 5 mL in individuals with ≥70 % stenosis. White matter hyperintensity volume and microstructural integrity did not differ between hemispheres. Conclusions: Carotid artery stenosis is associated with downstream presence of cortical microinfarcts as well as lower parenchymal tissue volume.
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spelling doaj-art-0b4987f1bfde4ffc9a34b2ca3d16e5972025-08-20T03:58:21ZengElsevierCerebral Circulation - Cognition and Behavior2666-24502025-01-01910039110.1016/j.cccb.2025.100391Effect of carotid artery stenosis on cortical microinfarcts, white matter integrity, and brain volume: An interhemispheric comparison within the population-based Rotterdam StudyFrank J. Wolters0Meike W. Vernooij1Gennady V. Roshchupkin2M․Arfan Ikram3Maryam Kavousi4Peter J. Koudstaal5Aad van der Lugt6Daniel Bos7Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands; Corresponding author at: Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands.Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the NetherlandsDepartment of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Medical Informatics, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the NetherlandsDepartment of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the NetherlandsDepartment of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the NetherlandsDepartment of Neurology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the NetherlandsDepartment of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the NetherlandsDepartment of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the NetherlandsBackground: Carotid artery stenosis could contribute to gradual loss of brain function through chronic hypoxia and ischemia. Methods: We included consecutive participants of the population-based Rotterdam Study with unilateral ≥50 % stenosis at the carotid artery bifurcation on time-of-flight carotid MR angiography, and compared between hemispheres the presence of ischemic lesions, tissue volumes, and white matter integrity on structural brain MRI. Results: Among 50 participants (mean age 76 years, 50 % women), flow was lower in the affected carotid artery than on the unaffected side (160mL/min versus 202mL/min; flow reduction [95 %CI] per 1 % increase in stenosis: 1.7 mL/min [1.0–2.5]). Twelve individuals had radiographic evidence of cortical infarction, of whom 8 had cortical microinfarcts, all on the side of the stenosis (P = 0.001). Downstream of the stenotic artery, parenchymal volume was lower than in the contralateral hemisphere (mean difference: -2.7 mL [-4.9;-0.4]), similar for grey and white matter. Differences were most profound in the frontoparietal lobes, and increased with severity of stenosis to roughly 5 mL in individuals with ≥70 % stenosis. White matter hyperintensity volume and microstructural integrity did not differ between hemispheres. Conclusions: Carotid artery stenosis is associated with downstream presence of cortical microinfarcts as well as lower parenchymal tissue volume.http://www.sciencedirect.com/science/article/pii/S2666245025000157Carotid artery stenosisCerebral blood flowCortical microinfarctsNeurodegenerationCerebral small-vessel disease
spellingShingle Frank J. Wolters
Meike W. Vernooij
Gennady V. Roshchupkin
M․Arfan Ikram
Maryam Kavousi
Peter J. Koudstaal
Aad van der Lugt
Daniel Bos
Effect of carotid artery stenosis on cortical microinfarcts, white matter integrity, and brain volume: An interhemispheric comparison within the population-based Rotterdam Study
Cerebral Circulation - Cognition and Behavior
Carotid artery stenosis
Cerebral blood flow
Cortical microinfarcts
Neurodegeneration
Cerebral small-vessel disease
title Effect of carotid artery stenosis on cortical microinfarcts, white matter integrity, and brain volume: An interhemispheric comparison within the population-based Rotterdam Study
title_full Effect of carotid artery stenosis on cortical microinfarcts, white matter integrity, and brain volume: An interhemispheric comparison within the population-based Rotterdam Study
title_fullStr Effect of carotid artery stenosis on cortical microinfarcts, white matter integrity, and brain volume: An interhemispheric comparison within the population-based Rotterdam Study
title_full_unstemmed Effect of carotid artery stenosis on cortical microinfarcts, white matter integrity, and brain volume: An interhemispheric comparison within the population-based Rotterdam Study
title_short Effect of carotid artery stenosis on cortical microinfarcts, white matter integrity, and brain volume: An interhemispheric comparison within the population-based Rotterdam Study
title_sort effect of carotid artery stenosis on cortical microinfarcts white matter integrity and brain volume an interhemispheric comparison within the population based rotterdam study
topic Carotid artery stenosis
Cerebral blood flow
Cortical microinfarcts
Neurodegeneration
Cerebral small-vessel disease
url http://www.sciencedirect.com/science/article/pii/S2666245025000157
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