Abstract
ObjectiveTo prospectively assess the relation between carotid plaque characteristics and the development of new cerebral white matter lesions (WMLs) at MRI.MethodsFifty TIA/stroke patients with ipsilateral 30–69% carotid stenosis underwent MRI of the plaque at baseline. Total plaque volume and markers of vulnerability to thromboembolism (lipid-rich necrotic core [LRNC] volume, fibrous cap [FC] status, and presence of intraplaque hemorrhage [IPH]) were assessed. All patients also underwent brain MRI at baseline and after one year. Ipsilateral cerebral WMLs were quantified with a semiautomatic method.ResultsMean WML volume significantly increased over a one-year period (6.52 vs. 6.97 mm3, P = 0.005). WML volume at baseline and WML progression did not significantly differ (P>0.05) between patients with 30–49% and patients with 50–69% stenosis. There was a significant correlation between total plaque volume and baseline ipsilateral WML volume (Spearman ρ = 0.393, P = 0.005). There was no significant correlation between total plaque volume and ipsilateral WML progression. There were no significant associations between LRNC volume and WML volume at baseline and WML progression. WML volume at baseline and WML progression did not significantly differ between patients with a thick and intact FC and patients with a thin and/or ruptured FC. WML volume at baseline and WML progression also did not significantly differ between patients with and without IPH.ConclusionThe results of this study indicate that carotid plaque burden is significantly associated with WML severity, but that there is no causal relationship between carotid plaque vulnerability and the occurrence of WMLs.
Highlights
Carotid atherosclerosis is an important cause of ischemic stroke
Large epidemiological studies showed that there is a relation between the presence and amount of carotid atherosclerosis and white matter lesions (WMLs) [2,3], which are frequently detected by magnetic resonance imaging (MRI) in the aging brain[4]
We found that carotid stenosis grade is not related to ipsilateral baseline WML volume, which is in line with results of earlier crosssectional studies investigating the relation between carotid plaque characteristics and WMLs at MRI [21,22,23]
Summary
Carotid atherosclerosis is an important cause of ischemic stroke. The pathogenesis of ischemic stroke due to carotid atherosclerosis can be ascribed to cerebral embolism from carotid plaque and/or hypoperfusion due to stenosis [1]. It has been shown that WMLs are a strong independent predictor of stroke [8,9] and global functional decline [10] It is unclear yet whether the relation between carotid atherosclerosis and WMLs is indirect via shared risk factors or causative in nature. To our knowledge, it has not been investigated yet whether the presence of certain carotid plaque features precedes the development of new WMLs. the purpose of the present study was to prospectively assess the relation between carotid plaque characteristics and cerebral WML progression at MRI
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