title: Cerebral white matter hyperintense lesions are associated with unstable carotid plaques.
abstract: OBJECTIVE
  The aim of this study was to determine whether unstable carotid plaques, a known risk factor for cerebral emboli, are associated with cerebral white matter lesions.
  
  
  METHODS
  Seventy-one symptomatic patients undergoing magnetic resonance imaging prior to carotid endarterectomy for high grade carotid stenosis were included in this study. The number and volume of white matter hyperintense lesions (WMHL) on fluid attenuated inversion recovery brain scans were compared according to the morphology of carotid plaque based upon the American Heart Association (AHA) histological classification.
  
  
  RESULTS
  Of the 57 patients who had good quality brain scans and non-fragmented carotid plaques, 15 plaques were defined as stable (type V) and 42 as unstable (type VI). After adjustment for the major risk factors affecting WMHL, unstable carotid plaques were found to be associated with more WMHL in the ipsilateral cerebral hemisphere than stable plaques (transformed means 2.50+/-1.2 vs. 1.53+/-1.1, p=0.016), however, there was only a trend towards larger WMHL volumes (p=0.079).
  
  
  CONCLUSIONS
  The observed association between unstable carotid plaques and the number of white matter lesions suggest that thromboembolic plaque activity may contribute to the development of leukoaraiosis, in particular smaller individual lesions. Larger studies are warranted to confirm this finding and explore the potential clinical impact for selecting candidates for carotid endarterectomy.
authors.affiliation: Department of Academic Radiology, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK. nish.altaf@nottingham.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Altaf
authors.forename: L
authors.initials: L
authors.lastname: Daniels
authors.forename: P S
authors.initials: PS
authors.lastname: Morgan
authors.forename: J
authors.initials: J
authors.lastname: Lowe
authors.forename: J
authors.initials: J
authors.lastname: Gladman
authors.forename: S T
authors.initials: ST
authors.lastname: MacSweeney
authors.forename: A
authors.initials: A
authors.lastname: Moody
authors.forename: D P
authors.initials: DP
authors.lastname: Auer
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000175:diagnosis; D049292:Leukoaraiosis / Q000175:diagnosis* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index