title: Sublingual microvascular glycocalyx dimensions in lacunar stroke patients.
abstract: BACKGROUND
  Cerebral small vessel disease is thought to result from endothelial dysfunction. The glycocalyx, lining the endothelium, is a major determinant of endothelial function. The glycocalyx is partially accessible to flowing red blood cells at its luminal side, called the perfused boundary region (PBR). Glycocalyx damage results in increased PBR, which can be measured in the sublingual microvasculature. We tested whether PBR is increased in patients with cerebral small vessel disease, i.e. lacunar stroke patients, and further distinguished patients with presence of white matter lesions as a sign of extensive cerebral small vessel disease.
  
  
  METHODS
  We used sidestream dark field imaging of the sublingual microcirculation in 31 lacunar stroke patients (6 with and 25 without white matter lesions) and 19 healthy controls. In each subject, automatic image analyzing software analyzed PBR in more than 3,000 vessel segments and the average dimension of glycocalyx PBR was determined in vessel segments with a diameter of 5-25 μm.
  
  
  RESULTS
  PBR did not differ between lacunar stroke patients and healthy controls (2.10 ± 0.25 vs. 2.08 ± 0.24 μm, p = 0.8). However, lacunar stroke patients with white matter lesions had an increased PBR compared with both healthy controls (2.35 ± 0.23 vs. 2.08 ± 0.24 μm, p = 0.03) and patients without white matter lesions (2.04 ± 0.22 μm, p = 0.004).
  
  
  CONCLUSIONS
  White matter lesions are associated with an increase in the red blood cell permeable part of the sublingual microvascular glycocalyx in lacunar stroke patients. This implicates compromised glycocalyx barrier properties, which is consistent with impaired endothelial function in lacunar stroke patients with white matter lesions.
authors.affiliation: Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Remy J H
authors.initials: RJ
authors.lastname: Martens
authors.forename: Hans
authors.initials: H
authors.lastname: Vink
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Oostenbrugge
authors.forename: Julie
authors.initials: J
authors.lastname: Staals
mesh_terms: D000368:Aged; D001812:Blood-Brain Barrier; D001921:Brain / Q000473:pathology; D004730:Endothelium, Vascular / Q000648:ultrastructure*; D004912:Erythrocytes; D005260:Female; D019276:Glycocalyx / Q000648:ultrastructure*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D055806:Microvessels / Q000648:ultrastructure*; D008875:Middle Aged; D009060:Mouth Floor; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000503:physiopathology*