title: Carotid stenosis: a risk factor for cerebral white-matter disease.
abstract: BACKGROUND
  We sought to study the association between carotid stenosis and white-matter hyperintensity (WMH) among patients without intracranial large-vessel stenosis.
  
  
  METHODS
  This was a prospective study of patients with acute lacunar infarcts without concomitant intracranial large-vessel stenosis having undergone carotid ultrasonography. WMH was quantified using the modified Fazekas scale. Patients were grouped into quartiles based on the degree of carotid stenosis. The association among carotid stenosis, vascular risk factors, and WMH were modeled using logistic regression analysis.
  
  
  RESULTS
  In all, 100 patients with a mean age of 56.2 ± 11.7 years were studied. The quartile with the greatest carotid stenosis had a mean internal/common carotid artery peak systolic velocity ratio of 2.36. Total WMH was 4.64 in the highest quartile and 2.52 in the lowest quartile of carotid stenosis. Periventricular (pv)-WMH was significantly greater between the highest and lowest quartiles (2.80 versus 1.28, P = .025). No significant difference was observed for deep subcortical WMH (1.84 versus 1.24, P = .281). With increasing carotid stenosis, increase in both ipsilateral and contralateral pv-WMH was observed. When patients with significant carotid stenosis were compared to those without significant carotid stenosis, pv-WMH was significantly higher in the group with significant stenosis even after correcting for age and comorbid vascular risk factors (odds ratio 1.24; confidence interval 1.0-1.54).
  
  
  CONCLUSIONS
  Carotid stenosis is an important risk factor for WMH. Volumes of pv-WMH significantly increase with higher grades of carotid stenosis.
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore; Duke-National University of Singapore Graduate Medical School, Singapore. Electronic address: Nagaendran_Kandiah@nni.com.sg.
authors.forename: Nagaendran
authors.initials: N
authors.lastname: Kandiah
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore.
authors.forename: Orlanda
authors.initials: O
authors.lastname: Goh
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore.
authors.forename: Elijah
authors.initials: E
authors.lastname: Mak
authors.affiliation: Case Management Unit, Tan Tock Seng Hospital, Singapore.
authors.forename: Maznah
authors.initials: M
authors.lastname: Marmin
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore.
authors.forename: Amanda
authors.initials: A
authors.lastname: Ng
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001783:Blood Flow Velocity; D001927:Brain Diseases / Q000453:epidemiology / Q000209:etiology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D016001:Confidence Intervals; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000453:epidemiology / Q000209:etiology; D014463:Ultrasonography