Carotid revascularization and hemispheric white matter disease progression

Area of Science:

• Neurology
• Vascular Medicine
• Radiology

Background:

• Carotid revascularization is established for preventing ischemic stroke in high-grade stenosis.
• The impact of carotid revascularization on white matter disease (WMD) progression remains uncharacterized.
• Understanding WMD progression is crucial for managing cerebrovascular health.

Purpose of the Study:

• To investigate the effect of carotid revascularization on hemispheric white matter disease (WMD) progression.
• To compare WMD volume changes in patients with carotid stenosis undergoing revascularization versus those who did not.
• To assess WMD progression asymmetry between hemispheres relative to revascularization status.

Main Methods:

• Longitudinal study of 150 patients (≥40 years) with moderate to severe carotid stenosis or occlusion.
• Serial brain MRIs (T2-FLAIR) analyzed for automated segmentation of hemispheric WMD volumes over ≥1 year.
• Multivariable linear regression models adjusted for demographics and vascular risk factors compared WMD progression rates.

Main Results:

• Revascularized patients showed numerically slower ipsilateral WMD progression (0.32 cm³/year) compared to non-revascularized patients (0.63 cm³/year).
• Carotid revascularization was associated with an attenuation of the hemispheric difference in WMD progression (p=0.019).
• The observed association did not meet the stringent Bonferroni-corrected significance threshold but remained directionally consistent.

Conclusions:

• Carotid revascularization demonstrated a trend towards slower ipsilateral WMD progression and reduced hemispheric asymmetry over a median 5-year follow-up.
• Findings are observational and hypothesis-generating, requiring cautious interpretation due to modest statistical significance.
• Further prospective studies are warranted to confirm these effects and explore potential cognitive benefits.