CHARACTERISTICS OF CAROTID ATHEROSCLEROSIS AND BRAIN WHITE MATTER HYPERINTENSITIES IN ASYMPTOMATIC PATIENTS WITH INTERMEDIATE STENOSIS

Aim: White matter hyperintensities (WMH) can be incidentally found in patients with carotid atherosclerosis on brain magnetic resonance imaging (MRI). They are believed to reflect cerebral ischemic burden. We investigated the relationship between carotid atherosclerosis and presence and extension of WMH in asymptomatic patients with carotid plaques of intermediate severity. Methods: We screened 235 consecutive patients with carotid stenosis <70% according to Doppler flow velocity measurements. After excluding patients with confounding causes of cerebral damage, 67 asymptomatic patients underwent carotid computed tomography angiography (CTA) and contrast enhanced ultrasound in order to fully characterize the extent of carotid atherosclerosis and carotid plaque features. The subjects then underwent brain MRI for the evaluation of WMH. Results: Number and volume of WMH were associated with a history of resistant hypertension, the entity of stenosis estimated with Doppler measurement and presence of an ulcerated plaque at CTA (all p<0.05). At multivariate regression analysis, resistant hypertension was independently associated with both number and volume of WMH, presence of an ulcer with number of WMH and degree of stenosis with WMH volume (all p<0.05). WMH were equally distributed in both hemispheres irrespectively of plaque location. Conclusions: In asymptomatic subjects with carotid plaques of intermediate severity, a higher burden of WMHs is associated with history of resistant hypertension that could be the expression of microvascular damage. Stenosis severity and presence of plaque ulceration are also associated with WMH burden although their direct pathophysiological role is not supported by the bilateral distribution of WMH.