Carotid artery atherosclerosis and white matter lesions in the elderly: a community-based MR imaging study

This study sought to evaluate the relationship between morphological and compositional characteristics of carotid atherosclerotic plaques and white matter lesions (WMLs) in asymptomatic elderly adults using three-dimensional (3D) multicontrast magnetic resonance (MR) vessel wall imaging.

Asymptomatic elderly subjects (≥ 60 years) were recruited from a community-based study. Carotid arteries and the brain were imaged on a 3.0-T MR scanner. The morphological and compositional features of carotid atherosclerotic plaques were evaluated. The WMLs were scored using the Fazekas criteria. The characteristics of carotid plaque were compared among different WML severities and the associations between carotid plaque characteristics and WMLs were analyzed.

In total, 123 elderly subjects (mean age: 71.9 ± 6.0 years, 55 males) were included. A significant difference was found in carotid MWT, presence of calcification, and high-risk plaque among subjects with different severity of WMLs (all p < 0.05). Univariate logistic regression analysis showed that carotid plaque calcification (OR, 5.357; 95% CI: 1.556-18.437, p = 0.008), intraplaque hemorrhage (OR, 4.952; 95% CI: 1.089-22.514, p = 0.038), and high-risk plaque (OR, 7.214; 95% CI: 1.929-26.974, p = 0.003) in carotid arteries were significantly associated with severe WML. After adjusting for the confounding factors, the significance of these associations was attenuated and only the association of high-risk plaque with severe WML remained statistically significant (OR, 8.829; 95% CI: 1.566-49.787; p = 0.014).

Carotid artery plaque compositional characteristics, especially high-risk plaque, were significantly associated with the severity of WMLs, suggesting that carotid vulnerable atherosclerotic plaque might be an independent indicator for cerebral small vessel disease in asymptomatic elderly adults.

Question The relationship between carotid atherosclerotic plaque characteristics and WMLs in asymptomatic elderly adults remains unclear. Findings High-risk carotid plaques are significantly associated with the severity of WMLs in the asymptomatic elderly. Clinical relevance Identifying carotid plaque characteristics, particularly high-risk plaques, may serve as an indicator for cerebral small vessel disease, aiding in early detection and management of related risks in the asymptomatic elderly.