To investigate the correlation between carotid plaque vulnerability and MRI imaging markers and overall burden of cerebral small vessel disease (CSVD).

From January 2018 to December 2018, patients with carotid plaque thickness ≥2 mm admitted to the Brain Disease Center, the Affiliated Hospital of Nanjing University of Chinese Medicine was enrolled prospectively. Contrast-enhanced ultrasonography (CEUS) was used to evaluate the vulnerability of carotid plaque. All patients underwent head MRI. Lacunar infarction, white matter hyperintensities, cerebral microbleeds and enlarged perivascular space were recorded and the overall burden of CSDV was calculated. Binary multivariate logistic regression analysis was used to determine the correlation between carotid vulnerable plaque and various imaging markers of CSVD. Ordinal multivariable logistic regression analysis was used to determine the correlation between the carotid vulnerable plaques and the overall burden of CSCD.

A total of 112 patients were included, including 61 (54.5%) in vulnerable plaque group and 51 (45.5%) in non-vulnerable plaque group. There were significant differences in the proportion of diabetes mellitus (49.2% vs. 19.6%; χ²=10.580, P<0.001), lacunar infarction (54.1% vs. 31.4%; χ²=5.829, P=0.016) and white matter hyperintensities (41.0% vs. 19.6%; χ²=5.907, P=0.015) between the vulnerable plaque group and the non-vulnerable plaque group. Multivariate logistic regression analysis showed that after adjusting for age, gender, hypertension, diabetes, and hyperlipidemia, there was a significant independent correlation between lacunar infarction (odds ratio [OR] 2.776, 95% confidence interval [CI] 1.139-6.765; P=0.025) and white matter hyperintensities (OR 3.969, 95% CI 1.465-10.753; P=0.007) and carotid vulnerable plaque. There were significant differences in age (F=4.275, P=0.003), past stroke history (χ²=11.100, P=0.025) and vulnerable plaque (χ²=9.829, P=0.043) in different CSVD burden groups. The overall burden of CSVD increased significantly with the increase of CEUS grade of carotid plaque (χ²=28.525, P=0.005). Ordinal multivariable logistic regression analysis showed that after adjusting for age, gender, hypertension, diabetes, coronary heart disease, stroke history, and smoking, there was still a significant independent correlation between the overall burden of CSVD and vulnerable plaques (OR 3.753, 95% CI 1.678-8.392; P=0.001).

Carotid vulnerable plaques were independently associated with lacunar infarction, white matter hyperintensities, and total burden of CSVD.

Cerebral small vessel diseases; Carotid stenosis; Plaque, atherosclerotic; Ultrasonography; Magnetic resonance imaging; Risk factors