Cerebral cortical microinfarcts in patients with internal carotid artery occlusion

J Cereb Blood Flow Metab. 2021 Oct;41(10):2690-2698. doi: 10.1177/0271678X211011288. Epub 2021 Apr 25.

Abstract

Cerebral cortical microinfarcts (CMI) are small ischemic lesions that are associated with cognitive impairment and probably have multiple etiologies. Cerebral hypoperfusion has been proposed as a causal factor. We studied CMI in patients with internal carotid artery (ICA) occlusion, as a model for cerebral hemodynamic compromise. We included 95 patients with a complete ICA occlusion (age 66.2 ± 8.3, 22% female) and 125 reference participants (age 65.5 ± 7.4, 47% female). Participants underwent clinical, neuropsychological, and 3 T brain MRI assessment. CMI were more common in patients with an ICA occlusion (54%, median 2, range 1-33) than in the reference group (6%, median 0; range 1-7; OR 14.3; 95% CI 6.2-33.1; p<.001). CMI were more common ipsilateral to the occlusion than in the contralateral hemisphere (median 2 and 0 respectively; p<.001). In patients with CMI compared to patients without CMI, the number of additional occluded or stenosed cervical arteries was higher (p=.038), and cerebral blood flow was lower (B -6.2 ml/min/100 ml; 95% CI -12.0:-0.41; p=.036). In conclusion, CMI are common in patients with an ICA occlusion, particularly in the hemisphere of the occluded ICA. CMI burden was related to the severity of cervical arterial compromise, supporting a role of hemodynamics in CMI etiology.

Keywords: Cerebral blood flow; cerebral hemodynamic compromise; cerebrovascular disease; internal carotid artery occlusion; microinfarct.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Carotid Artery Diseases / complications*
  • Carotid Artery Diseases / physiopathology
  • Carotid Artery, Internal / diagnostic imaging*
  • Carotid Stenosis / physiopathology*
  • Cerebrovascular Circulation / physiology*
  • Female
  • Humans
  • Male
  • Risk Factors