title: Long-term effects of white matter changes on the risk of stroke recurrence after carotid artery stenting in patients with symptomatic carotid artery stenosis.
abstract: BACKGROUND
  Cerebral white matter changes (WMC) are associated with increased 30-day perioperative risk of stroke in patients undergoing carotid artery stenting (CAS). However, there is no data showing their impact on postoperative long-term stroke recurrence or survival. It remains unknown whether this effect is independent of classic cardiovascular risk factors or not. We tried to assess the effects of WMC on long-term stroke recurrence after CAS in patients with symptomatic carotid stenosis.
  
  
  METHODS
  A database of patients with symptomatic carotid stenosis who had undergone CAS was sampled in a single Chinese medical center from 2007 to 2014. Copies of baseline brain imaging were analyzed by two investigators to evaluate the severity of WMC. We analyzed the association between WMC and stroke recurrence after CAS by reviewing case histories and conducting telephone interviews, with a mean follow-up time of 28months.
  
  
  RESULTS
  107 patients with an average age of 66years fulfilled the inclusion criteria, of which 70 were examined with CT and the remainder by MRI. In our cohort, 91.6% of the participants were male. There were 29 patients with diffuse WMC. In univariate analysis, patients with diffuse WMC had more contralateral occlusion than those with non-diffuse WMC. In patients with diffuse WMC, more stroke recurrences were observed compared with those with non-diffuse WMC (hazard ratio [HR] 3.516; 95% CI 1.176, 10.510, P=0.024).
  
  
  CONCLUSIONS
  In patients with symptomatic carotid artery stenosis, diffuse WMC were a risk factor for stroke recurrences after CAS. Larger studies are warranted to confirm this finding and explore the potential clinical impact of WMC so as to better determine treatment strategies for patients with symptomatic carotid artery stenosis.
authors.affiliation: Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Yu
authors.affiliation: Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China. Electronic address: hansletter@163.com.
authors.forename: Xiang
authors.initials: X
authors.lastname: Han
authors.affiliation: Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Xiao Long
authors.initials: XL
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.affiliation: Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China. Electronic address: qiang_dong163@126.com.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Dong
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: Carotid artery stenting; Stroke recurrence; Symptomatic carotid artery stenosis; White matter changes