Abstract TMP67: Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy May Affect Large Cerebral Arteries

Abstract

Introduction: CADASIL is the most common monogenic small-vessel disease (SVD) form. Large and small brain arteries are intimately related, but it is unclear whether people with CADASIL have changes in their large arteries as a result. We hypothesized that CADASIL patients have affected large arteries compared to controls. Methods: We conducted a comparative analysis by matching 37 CADASIL patients with 104 lacunar stroke patients from the NYP/ Columbia University Medical Center Stroke Registry Study matched by age +/-3 and sex. We measured the basilar and intracranial carotid artery diameters in both groups in T2 MRI images. We rated cervical artery tortuosity as 0 for no tortuosity, 1 for 45-90°, and 2 for >90°. We ran generalized linear models to compare cases and controls, adjusting for demographics and clinical variables. Results: Patients with CADASIL were less likely Hispanic\Latino (10.8% vs. 51.9%, p=<0.001), hypertensive (27% vs. 73.1%, p=<0.001), current smokers (5.4%vs. 22.1%, p=0.024), but more likely to have a prior stroke (56.8% vs. 24%, p=<0.001) than controls—Table 1. In the adjusted model, patients with CADASIL had larger basilar artery diameters (p=0.007) and a statistical trend for greater cervical carotid artery tortuosity—Table 2. Conclusions: Although traditionally considered an example of pure SVD, patients with CADASIL have a higher prevalence of cervical tortuosity and intracranial artery dilatation. Whether changes in large arteries result from small artery disease or part of the NOTCH3 mutation phenotype is uncertain. Further investigation is needed to determine if large artery involvement influences the clinical manifestations of CADASIL.