Hemodynamic significance of intracranial atherosclerotic disease and ipsilateral imaging markers of cerebral small vessel disease

Lina Zheng, Xuan Tian, Jill Abrigo, Hui Fang, Bonaventure YM Ip, Yuying Liu, Shuang Li, Yu Liu, Linfang Lan, Haipeng Liu, Hing Lung Ip, Florence SY Fan, Sze Ho Ma, Karen Ma, Alexander Y Lau, Yannie OY Soo, Howan Leung, Vincent CT Mok, Lawrence KS Wong , Yuming XuLiping Liu, Xinyi Leng, Thomas W Leung

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Introduction: Cerebral small vessel disease (CSVD) commonly exists in patients with symptomatic intracranial atherosclerotic disease (sICAD). We aimed to investigate the associations of hemodynamic features of sICAD lesions with imaging markers and overall burden of CSVD. Patients and methods: Patients with anterior-circulation sICAD (50%–99% stenosis) were analyzed in this cross-sectional study. Hemodynamic features of a sICAD lesion were quantified by translesional pressure ratio (PR = Pressurepost-stenotic/Pressurepre-stenotic) and wall shear stress ratio (WSSR = WSSstenotic-throat/WSSpre-stenotic) via CT angiography-based computational fluid dynamics modeling. PR ⩽median was defined as low (“abnormal”) PR, and WSSR ⩾ fourth quartile as high (“abnormal”) WSSR. For primary analyses, white matter hyperintensities (WMHs), lacunes, and cortical microinfarcts (CMIs) were assessed in MRI and summed up as overall CSVD burden, respectively in ipsilateral and contralateral hemispheres to sICAD. Enlarged perivascular spaces (EPVSs) and cerebral microbleeds (CMBs) were assessed for secondary analyses. Results: Among 112 sICAD patients, there were more severe WMHs, more lacunes and CMIs, and more severe overall CSVD burden ipsilaterally than contralaterally (all p < 0.05). Abnormal PR and WSSR (vs normal PR and WSSR) was significantly associated with moderate-to-severe WMHs (adjusted odds ratio = 10.12, p = 0.018), CMI presence (5.25, p = 0.003), and moderate-to-severe CSVD burden (12.55; p = 0.033), ipsilaterally, respectively independent of contralateral WMHs, CMI(s), and CSVD burden. EPVSs and CMBs were comparable between the two hemispheres, with no association found with the hemodynamic metrics. Discussion and conclusion: There are more severe WMHs and CMI(s) in the hemisphere ipsilateral than contralateral to sICAD. The hemodynamic significance of sICAD lesions was independently associated with severities of WMHs and CMI(s) ipsilaterally.
Original languageEnglish
Pages (from-to)144-153
Number of pages10
JournalEuropean Stroke Journal
Issue number1
Early online date6 Oct 2023
Publication statusE-pub ahead of print - 6 Oct 2023

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The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Direct Grant for Research, Chinese University of Hong Kong (Reference No. 2020.033); General Research Fund (Reference No. 14106019); and Early Career Scheme (Reference No. 24103122), Research Grants Council of Hong Kong; and Li Ka Shing Institute of Health Sciences.


  • Cerebral small vessel disease
  • hemodynamics
  • intracranial atherosclerotic disease
  • white matter hyperintensity
  • cortical microinfarct


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