Perforating artery flow velocity and pulsatility in patients with carotid occlusive disease. A 7 tesla MRI study

Patients with carotid occlusive disease express altered hemodynamics in the post-occlusive vasculature and le-sions commonly attributed to cerebral small vessel disease (SVD). We addressed the question if cerebral perfo-rating artery flow measures, using a novel 7T MRI technique, are altered and related to SVD lesion burden in patients with carotid occlusive disease.21 patients were included with a uni-(18) or bilateral (3) carotid occlusion (64 & PLUSMN;7 years) and 19 controls (65 & PLUSMN;10 years). Mean flow velocity and pulsatility in the perforating arteries in the semi-oval center (CSO) and basal ganglia (BG), measured with a 2D phase contrast 7T MRI sequence, were compared between patients and controls, and between hemispheres in patients with unilateral carotid occlusive disease. In patients, relations were assessed between perforating artery flow measures and SVD burden score and white matter hyperintensity (WMH) volume.CSO perforating artery flow velocity was lower in patients than controls, albeit non-significant (mean dif-ference [95% confidence interval] 0.08 cm/s [0.00-0.16]; p = 0.053), but pulsatility was similar (0.07 [-0.04-0.18]; p = 0.23). BG flow velocity and pulsatility did not differ between patients and controls (velocity = 0.28 cm/s [-0.32-0.88]; p = 0.34; pulsatility = 0.00 [-0.10-0.11]; p = 0.97). Patients with unilateral carotid occlusive disease showed no significant interhemispheric flow differences. Though non-significant, within pa-tients lower CSO (p = 0.06) and BG (p = 0.11) flow velocity related to larger WMH volume.Our findings suggest that carotid occlusive disease may be associated with abnormal cerebral perforating artery flow and that this relates to SVD lesion burden in these patients, although our observations need corroboration in larger study populations.

Automated summary

The study suggests that carotid occlusive disease may be associated with abnormal cerebral perforating artery flow and that this relates to the burden of small vessel disease lesions in these patients.