Cerebral and Extracerebral Vasoreactivity in Patients With Different Clinical Manifestations
of Cerebral Small-Vessel Disease: Data From the Significance of Hemodynamic and Hemostatic
Factors in the Course of Different Manifestations of Cerebral Small-Vessel Disease
Staszewski, Jacek ✉; Skrobowska, Ewa; Piusinska-Macoch, Renata; Brodacki, Bogdan; Stepien, Adam
Objectives Endothelial dysfunction has been implicated in the pathogenesis of cerebral
small-vessel disease (SVD). Little is known about the relationship between SVD and
measures of endothelium-dependent vasodilatation and cerebral vasomotor reactivity.
The aim of this study was to evaluate cerebral and extracerebral endothelial dysfunction
in patients with different manifestations of SVD and to assess the relationship between
endothelial dysfunction and radiologic markers of SVD. Methods The vasomotor reactivity
reserve (VMRr), breath-holding index (BHI) of the middle cerebral arteries, and brachial
artery flow-mediated dilatation (FMD) were measured with ultrasound techniques in
90 patients (30 in each group) older than 60 years with extensive white matter lesions
(Fazekas grade >= 2) with a history of lacunar stroke, vascular dementia, or parkinsonism
and 30 individuals with normal magnetic resonance imaging findings (control group).
All groups were matched for age, sex, hypertension, and diabetes. Results The mean
age +/- SD (71.8 +/- 3.4 versus 71.7 +/- 3.4 years), sex distribution, and prevalence
of the main vascular risk factors were similar in the SVD and control groups. The
VMRr (56.6% +/- 18.3% versus 77.1% +/- 16.9%), BHI (0.8 +/- 0.3 versus 1.1 +/- 0.4),
and FMD (5.8% +/- 4 versus 12.1% +/- 5.2%) were severely impaired in the SVD groups
compared to the control group (P < .01). The vascular responses to all tests was similar
in the SVD groups, but they were significantly decreased in patients with severe white
matter lesions, marked brain atrophy, and enlarged perivascular spaces. Conclusions
This study was the first that simultaneously evaluated cerebral and extracerebral
vasodilator responses in a well-phenotyped cohort of patients with lacunar stroke,
vascular dementia, or parkinsonism. The VMRr, BHI, and FMD were more severely impaired
in patients with SVD, regardless of its clinical manifestation, than in control participants.
All measures were significantly lower in patients with severe white-matter lesions,
brain atrophy, or enlarged perivascular spaces.