# The Effect of Cranio-Cervical Artery Stenosis on Glymphatic System Function in Patients with Cerebral Infarction

## TL;DR

This study shows that aging, cerebral infarction, and cranio-cervical artery stenosis all impair the brain's glymphatic system, with infarction having the strongest impact.

## Contribution

The study identifies a synergistic effect between cerebral infarction and cranio-cervical artery stenosis on glymphatic system dysfunction.

## Key findings

- Age, cerebral infarction, and CAS independently predict lower glymphatic system function.
- CI and CAS have a synergistic effect, worsening glymphatic system dysfunction more than either alone.
- GS function was most impaired in patients with both CI and CAS compared to controls.

## Abstract

Background/Objectives: The aim of this study was to investigate the effects of cranio-cervical artery stenosis (CAS) and cerebral infarction (CI) on the function of the glymphatic system (GS). Methods: Hospitalised patients with CI and/or CAS were enrolled, along with a control group. A total of 111 participants (62.68 ± 9.85 years; 37% female) were enrolled in this study. GS function was assessed using the diffusion tensor imaging analysis along with the perivascular space (DTI-ALPS) method. The influencing factors and the individual and combined effects of CI and CAS on the DTI-ALPS index were analysed. Results: Age (p = 0.024), CI (p < 0.001), and CAS (p = 0.001) were independent predictors of a lower DTI-ALPS index. There were statistically significant differences in the DTI-ALPS index among the four groups (CI, CAS, CI + CAS, control) (F(3, 107) = 91.4, p < 0.0001). The DTI-ALPS index was lower in the CI, CAS, and CI + CAS groups compared with the control group (p < 0.0001); in the CI group compared with the CAS group (p < 0.0001); and in the CI + CAS group compared with the CI group (p < 0.05). CI and CAS were found to have a significant interaction effect on the DTI-ALPS index (F(1, 107) = 6.43, p = 0.013). Conclusions: Aging, CAS, and CI independently impair GS function, with CI having a stronger effect. All three are independent predictors of GS dysfunction. Patients with CAS experience more significant GS dysfunction after suffering CI than patients without CAS. CI and CAS have a synergistic effect on GS impairment.