Intracranial artery stenosis is associated with cortical thinning in stroke-free individuals of two longitudinal cohorts

• Published in: Journal of the neurological sciences 2023-01, Vol.444, p.120533-120533, Article 120533
• Main Authors: Yang, Dixon, Masurkar, Arjun V., Khasiyev, Farid, Rundek, Tatjana, Wright, Clinton B., Elkind, Mitchell S.V., Sacco, Ralph L., Gutierrez, Jose
• Format: Article
• Language: English
• Subjects: Arteries - pathology; Atherosclerosis; Carotid Stenosis; Cerebral Cortical Thinning; Constriction, Pathologic - diagnostic imaging; Cortical thickness; Cross-Sectional Studies; Humans; Intracranial Arteriosclerosis - complications; Intracranial Arteriosclerosis - diagnostic imaging; Intracranial artery stenosis; Magnetic Resonance Imaging; Neurodegeneration; Noma; Stroke - diagnostic imaging
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2022.120533

We examined the association between asymptomatic intracranial artery stenosis (aICAS) and cortical thickness using brain magnetic resonance morphometry in two cohorts. This cross-sectional study included stroke-free participants from the Northern Manhattan Study (NOMAS) and the National Alzheimer's Coordinating Center (NACC). We represented the predictor aICAS in NOMAS as a continuous global stenosis score reflecting an overall burden of stenosis (possible range 0–44) assessed by magnetic resonance angiography and in NACC as a dichotomous autopsy-determined Circle of Willis (CoW) atherosclerosis (none-mild vs moderate-severe). The primary outcome of interest was total cortical thickness. We analyzed each dataset separately using multivariable linear regression. The analysis included 1209 NOMAS (46% had any stenosis, 5% had ≥70% stenosis of at least one vessel; stenosis score range 0–11) and 392 NACC (36% moderate-severe CoW atherosclerosis) participants. We found an inverse relationship between stenosis score and total cortical thickness (β-estimate [95% confidence interval (CI)]: −2.98 [−5.85, −0.11]) in adjusted models. We replicated these results in NACC (β-estimate [95% CI]: −0.06 [−0.11, −0.003]). Post-hoc, we segregated stenosis scores by location and only posterior circulation stenosis score was associated with total cortical thickness (anterior β-estimate [95% CI]: −0.90 [−5.16, 3.36], posterior β-estimate [95% CI]: −7.25 [−14.30, −0.20]). We found both radiographically and neuropathologically determined aICAS to be associated with global cortical thinning. Interestingly, posterior circulation stenoses appeared to drive this association with global cortical thinning, raising the possibility of pathophysiologic mechanisms for cortical thinning other than impaired hemodynamics. •Asymptomatic intracranial artery stenosis is associated with cortical thinning.•This relationship was independent of vascular risk factors and Alzheimer's disease•Posterior circulation stenoses drove the finding, implying non-hemodynamic causes