ABSTRACT NUMBER: ESOC2026A2115 NEUROIMAGING EVIDENCE OF PARANASAL SINUSITIS: LINKED TO CEREBRAL SMALL VESSEL DISEASE AND SUBCLINICAL ATHEROSCLEROSIS, BUT NOT TO CAROTID REMODELING OR PLAQUE VULNERABILITY

Abstract Background and aims Incidental paranasal sinusitis (IPS), defined as mucosal thickening on cranial MRI or CT performed for non-sinus indications, is a common radiological finding. Its potential contribution to atherosclerosis-related cerebral vessel disease and acute vascular events remains unclear Methods This prospectively collected, retrospectively analyzed case-control study evaluated IPS as a risk marker for ischemic stroke. Associations were examined with CT-angiography-derived carotid atherosclerosis features (plaque size, geometry, morphology, composition, and content) and carotid tortuosity indices in acute stroke patients. IPS relevance to subclinical atherosclerosis was assessed using ultrasonography-determined intima-media thickness (IMT) and plaque burden, and to cerebral small vessel disease in asymptomatic individuals through MRI-defined markers of white matter hyperintensities, microbleeds, lacunes, perivascular spaces, and cerebral atrophy. Multiple regression analyses provided adjusted p-values. Results In acute ischemic stroke patients (n=262), paranasal sinus occupation >25% was numerically lower than in controls (19.4% vs. 26.8%, p=0.053). IPS-positive stroke cases showed no differences in carotid plaque burden, vulnerability, or tortuosity. In healthy controls, IPS was associated with higher IMT (694±134 vs. 643±136 microns, adj-p=0.032). MRI markers indicated greater cerebral small vessel disease: higher periventricular Fazekas scores (18% vs. 5%, adj-p=0.044), basal ganglion perivascular space scores (12.5% vs. 2.9%, adj-p=0.027), and chronic lacunae (12.5% vs. 3.5%, adj-p=0.033). White matter hyperintensity volume showed a nonsignificant trend. Carotid plaque burden and cerebral atrophy metrics did not differ by IPS status. Conclusions IPS correlates with increased IMT and greater severity of cerebral small vessel disease, suggesting chronic sinusitis may contribute to systemic subclinical atherosclerosis and cerebral microvascular changes. Conflict of interest "Ezgi Yılmaz: nothing to disclose", "Tugba Ozum: nothing to disclose", Ezgi yetim: Nothing to Disclose", Ethem Murat Arsava: nothing to disclose" and Mehmet akif Topcuoglu: nothing to disclose"