Background: Interactions between intracranial arterial pathologies (IAP) and cerebral small vessel disease (SVD) are an increasingly debated topic.
Hypothesis: We analyzed associations between the type/severity of SVD and two IAPs, the intracranial arterial calcifications (ICAC) and intracranial stenosis (ICS) in intracerebral hemorrhage (ICH) patients.
Methods: Consecutive ICH patients from a prospective cohort were included. Patients were divided into those meeting Boston criteria for cerebral amyloid angiopathy (CAA) and those with strictly deep hypertensive ICH consistent with hypertensive SVD (HTN-SVD). White matter hyperintensity volume (WMH) and microbleed count (MB) were quantitatively measured on MRI as markers of SVD severity. Head CT angiography was rated for presence of ICAC and for presence of >50% intracranial arterial stenosis (ICS). Associations of IAPs with the type of SVD (CAA vs HTN) as well as imaging markers of SVD severity were analyzed in multivariate models. We also explored the association between IAPs and presence of pre-ICH dementia.
Results: The cohort included 253 CAA patients and 90 HTN-SVD. CAA patients were older (73.5 vs 64.8, p<0.001), demonstrating higher WMH (25ml vs 16ml, p<0.001) but lower prevalence of hypertension than HTN-ICH. In univariate comparisons between CAA and HTN-SVD, the presence of ICACs (74% vs 72%, p=0.7) and ICS (7% vs 7.8%, p=0.8) were not different. ICS was not related to the type of SVD in multivariate models either. Using multivariate logistic regression, HTN-SVD was independently associated with presence of ICAC (adjusted OR = 2.56 [95% CI 1.1-6.2, p=0.002), as well as older age, male gender and hypercholesterolemia. We found no association between IAPs and parenchymal markers of SVD severity (WMH and MB) (all p>0.2) and no association with presence of dementia before ICH (p>0.2).
Conclusions: HTN-SVD is associated with increased ICAC in multivariate models, suggesting either shared risk factors or direct interactions between SVD and IAP. There is no association of intracranial large artery pathologies (ICAC, ICS) with parenchymal (WMH, MB) or clinical (dementia) consequences of cerebral small vessel diseases.