Correlation between the severity of enlarged perivascular space and retinal vessel abnormalities in mild stroke and transient ischemic attack

Abstract

Objective To investigate the relationship between enlarged perivascular space (EPVS) and retinal vessel abnormalities in transient ischemic attack (TIA) and mild stroke patients. Methods TIA and mild cerebral infarction (National Institutes of Health Stroke Scale score≤3) patients were enrolled from March to August 2019 in Changzhou Second People′s Hospital. Magnetic resonance imaging and retinal fundus photography were performed in all patients. Retinal arteriovenous diameter was semi-automatically measured, and retinal arteriosclerosis grades, vascular curvature, hemorrhages, microangioma, hard exudation, soft exudation, arteriovenous nicking and venous beads were assessed. Patients were divided into two groups according to the existence of EPVS: EPVS group and non-EPVS group. The baseline data of the two groups were compared and further multivariate Logistic regression was carried out. After normal transformation of the number of EPVS, the correlation between the grades of EPVS and converted EPVS was analyzed. The relationship between the number of converted EPVS and the grades and retinal fundus vascular lesions was further analyzed. Results A total of 123 patients were included, including 99 patients with cerebral infarction, 24 patients with TIA; 52 patients without EPVS and 71 patients with EPVS. The EPVS group was more than the non-EPVS group in age ((68.61±12.71) years and (63.37±13.53) years, t=-2.198, P=0.030), history of hypertension (52 (73.2%) and 25 (48.1%), χ2=8.118, P=0.004), hemangioma (17 (23.9%) and 5 (9.6%), χ2=4.196, P=0.041), arteriovenous nicking (50 (70.4%) and 8 (15.4%), χ2=36.488, P<0.05) and arteriosclerosis grades (1 (1, 2) and 0 (0, 1), Z=-7.454, P<0.05), and less than the non-EPVS group in central retinal artery equivalent (CRAE; (106.31±15.02) mm and (113.89±11.86) mm, t=3.014, P=0.003) and arteriole-to-venule ratio (AVR; 0.54±0.07 and 0.59±0.05, t=4.553, P<0.05). Multivariate Logistic regression analysis showed arteriosclerosis grades (OR=7.781, 95%CI 2.876-21.055, P<0.05) and hypertension (OR=3.203, 95%CI 1.049-9.777, P=0.041) were related factors for EPVS. Adjusting for age, sex, hypertension and diabetes, the normally transformed EPVS was found positively correlated with arteriovenous nicking (B=0.556, 95%CI 0.203-0.910, P=0.003) and arteriosclerosis grade (B=0.417, 95%CI 0.259-0.576, P<0.05), and negatively correlated with AVR (B=-4.213, 95%CI-6.712--1.714, P=0.001). The grades of EPVS were positively correlated with arteriosclerosis (r=0.764, P<0.05), and negatively correlated with CRAE (r=-0.287, P<0.05) and AVR (r=-0.422, P<0.05). Conclusions Hypertension and retinal arteriosclerosis are related factors of EPVS in mild stroke and TIA patients. EPVS is correlated with retinal vessel abnormalities. The more serious of EPVS is, the more serious of retinal arteriosclerosis is, the higher ratio of arteriovenous nicking is, the smaller of CRAE and AVR are. Key words: Perivascular space; Retina; Microvessels; Brain infarction; Fundus oculi; Arteriosclerosis