Relationship between Obesity and Pressure Ratio in Symptomatic Intracranial Atherosclerosis
WANG Anqi, WANG Anxin, ZHANG Yijun, JIANG Yong, ZHANG Yaqing, LIU Li, FU Shengqi, QIN Haiqiang, LIU Gaifen
2023, 18(12):
1405-1412.
DOI: 10.3969/j.issn.1673-5765.2023.12.010
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Objective To investigate the association between obesity and reduced translesional pressure ratio (PR) in patients with symptomatic intracranial atherosclerosis stenosis (sICAS).
Methods Data from this study were obtained from the Chinese National Stroke Registry Ⅲ (CNSR-Ⅲ). sICAS patients with HR-MRI data in the database were included. Three-dimensional meshes were created based on TOF-MRA, and pressure values were obtained by modeling with a finite element method. A PR of≤0.76 between distal and proximal pressure of the stenosis indicated diminished residual blood flow after stenosis. Patients were divided into low or normal weight group, overweight group and obese group according to the BMI. The association between obesity and PR reduction was analyzed by logistic regression, the confounding factors that may affect PR value such as age, sex, history of smoking, history of heavy drinking, history of hypertension, history of diabetes, dyslipidemia, and degree of stenosis were adjusted.
Results A total of 438 patients [median age 64 (57-71) years, 148 cases (33.79%) were female] were included in the analysis. The median PR of the low or normal weight group, the overweight group and the obese group were 0.90 (0.78-0.96), 0.89 (0.73-0.96) and 0.82 (0.52-0.94), respectively, and the difference between the three groups was statistically significant (P=0.044). Multifactorial logistic regression analysis showed that after adjusting for age, sex, history of smoking, history of heavy drinking, history of hypertension, history of diabetes, dyslipidemia and degree of stenosis, obesity was the risk factor for reduced PR in sICAS patients (OR 2.551, 95%CI 1.328-4.902, P=0.005). In addition, in subgroup analysis by age, adjusted for sex, smoking history, heavy drinking history, hypertension history, diabetes history, dyslipidemia, and degrees of stenosis, obesity was the risk factor for reduced PR in patients ≥65 years of age (OR 2.913, 95%CI 1.118-7.590, P=0.029). In subgroup analysis by gender, in female patients, adjusted for age, history of hypertension, history of diabetes, dyslipidemia and degrees of stenosis, obesity was still the risk factor for reduced PR in sICAS patients (OR 3.673, 95%CI 1.174-11.493, P=0.002).
Conclusions Obesity may be a risk factor for reduced PR in sICAS patients. Whether PR can be improved and cerebral perfusion increased by weight loss needs further study.
