Correlation Between White Matter Lesions And Internal Carotid Artery Stenosis:Evaluation With CT Angiography

ObjectiveWhite matter lesion is a common imaging manifestation of cerebral small vessel disease,which is closely related to the occurrence of acute stroke,nerve degeneration and deterioration,and depression.Carotid artery stenosis causes cerebral perfusion reduction,which may further cause white matter ischemia and hypoxia.By exploring the correlation between white matter lesion and carotid artery stenosis,comparing the changes of carotid artery stenosis rate in patients with different white matter lesions,and the correlation between white matter lesion and plaque composition and vascular remodeling in the narrowest part,we can further understand the risk factors of white matter lesion and provide some guidance for the formulation of clinical treatment strategies for stroke patients.Materials and MethodsPatients who underwent computed tomography angiography(CTA)in our hospital from June 2020 to June 2022 were collected,and 140 patients with carotid plaque were included.The severity of white matter lesions was assessed using the Blennow classification scale.The carotid stenosis rate was measured according to the standard definition of the North American symptomatic carotid endarterectomy trial.The Hounsfield-Unit(HU)threshold proposed by de Weert and his colleagues was used to determine the composition type in the plaque.At the same time,the way of lumen remodeling at the narrowest carotid artery was recorded.Firstly,the patients were divided into WML group and non-WML group.Univariate analysis was used to compare the differences in clinical data and internal carotid artery stenosis rate,stenosis degree,plaque type and vascular remodeling between the two groups.Secondly,according to the range and degree of white matter lesions in the Blennow score,the patients were grouped(0-3 groups,0 group represents the normal white matter group).Subsequently,Spearman was used to analyze the correlation between the range and degree of WML lesions and the stenosis rate,stenosis degree and plaque composition of internal carotid artery.Kruskal-Wallis test was used to analyze the intra-group difference of internal carotid artery stenosis rate.Finally,the risk factors of white matter lesions were screened by multivariate analysis.ResultsClinical data analysis showed that the single factor analysis between clinical features and WML showed that age,hypertension,previous stroke history,calcification,fiber and lipid in the most narrow part of carotid artery,positive remodeling,stenosis degree and stenosis rate in the most narrow part were statistically different from those with or without WML.There was no significant difference in gender,diabetes,hyperlipidemia,coronary heart disease and atrial fibrillation.Spearman correlation analysis showed that the range of WML lesions was positively correlated with stenosis rate,stenosis degree,fiber and lipid in the most narrow plaque(P<0.05).The range of WML lesions was negatively correlated with the calcification components in the plaque at the most stenosis of the carotid artery.The degree of WML was positively correlated with the stenosis rate,the degree of stenosis,the fiber and lipid in the most narrow plaque(P<0.05).The range of WML lesions was negatively correlated with the calcification components in the plaque at the most stenosis of the carotid artery.At the same time,compared with patients with normal white matter,patients with WML have a higher rate of internal carotid artery stenosis,a higher probability of unstable components in the plaque(such as fiber and lipid deposition in the plaque),and a higher probability of positive vascular remodeling.For WML patients,patients with a higher Blennow score had a higher rate of internal carotid artery stenosis.Multivariate logistic regression analysis showed that age and the stenosis rate of the narrowest part of the internal carotid artery were independently associated with WML.By drawing the pyramid of age distribution between the WML group and the non-WML group,it can be seen that in the WML group,the patients are older,and the accumulation between 63-74 years old is particularly prominent;in patients without WML,the age distribution of patients was more extensive.Conclusions1.Compared with the non-WML group,the stenosis rate and stenosis degree of the WML group were higher;plaques are mostly unstable plaques,and the risk of plaque rupture is relatively high.And the narrowest lumen is mostly positive remodeling.2.In the internal carotid artery plaque components,fiber and lipid have a positive role in promoting the occurrence and development of WML lesion range and lesion degree,and calcification has a protective effect on the occurrence of WML.3.In the comparison of WML group,in terms of WML lesion range,except for grade 1,the lesion range expanded with the increase of internal carotid artery stenosis rate.In terms of the degree of WML lesions,the severity of the lesions increased with the increase of internal carotid artery stenosis.4.Age and carotid stenosis rate are independent risk factors.Compared with the non-WML group,patients with WML are older.