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. 2025 Jun 27:4:1559481.
doi: 10.3389/fnimg.2025.1559481. eCollection 2025.

Association of cervical artery stenosis with common cerebral microvascular lesions and coronary artery calcifications

Chiheb Louizi  1 , Eya Khadhraoui  2   3 , Joachim Lotz  1   4   5 , Daniel Behme  2   3 , Erelle Fuchs  3 , Johannes T Kowallick  1   4 , Sebastian J Müller  2   3
Affiliations

Association of cervical artery stenosis with common cerebral microvascular lesions and coronary artery calcifications

Chiheb Louizi et al. Front Neuroimaging. .

Abstract

Background: A connection between cerebral white matter hyperintensities and coronary artery disease is widely discussed. Both conditions are more prevalent in the elderly. While white matter hyperintensities are often associated with small vessel disease, atherosclerosis is the primary cause of coronary artery disease.

Methods: We evaluated staging CT scans of the body and staging brain MRIs from patients with newly diagnosed malignant melanoma (without metastasis) between 01/01/2015 and 06/30/2023. CT scans were assessed for coronary artery disease using a modified overall visual assessment. Fazekas scores were used to evaluate the MRI for white matter changes. Additional clinical data were obtained from digital patient records.

Results: We analyzed data from 120 patients (57 females, mean age 68 years, standard deviation 14 years) and found a correlation between coronary artery disease and both age (r = 0.48, α = 0.04) and Fazekas score (periventricular r = 0.46, subcortical and deep white matter r = 0.55). A linear model including age, coronary artery disease, diabetes and arterial hypertension served as a predictor for white matter disease and showed significant correlations. Adding (1) atherosclerosis as well as (2) carotid stenosis to the model resulted in (1) a slight decrease in significance and (2) the unmasking of a potential spurious correlation with carotid stenosis.

Conclusion: There is a significant correlation between white matter hyperintensities and both carotid stenoses and coronary artery disease. This finding is clinically relevant: in patients with white matter hyperintensities and coronary artery disease, carotid stenosis should be ruled out.

Keywords: Fazekas score; atherosclerosis; cervical artery stenosis; coronary artery calcification; microvascular lesion.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A,B) MRI axial T2/FLAIR images of two patients. (A) Arrow points at single microvascular lesions (Fazekas score 1). (B) Arrows point at multiple confluent microvascular lesions (Fazekas score 2–3). (C,D) Contrast enhanced computed tomography scan showing severe coronary calcifications. (C) Axial. (D) Coronary.
Figure 2
Figure 2
(A) Example of none CAC (score of 0). (B) Example of mild CAC (score of 1). (C) Example of moderate CAC (score of 2). (D) Example of severe CAC (score of 3).
Figure 3
Figure 3
Distribution of measured white matter hyperintensities following Fazekas. DWM, deep white matter; PVWM, periventricular white matter.
Figure 4
Figure 4
Distribution of measured (single vessel) coronary artery calcifications. RCA, right coronary artery; LCA, left coronary artery; LAD, left anterior descending artery; RCX, ramus circumflex artery.
See this image and copyright information in PMC

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