AUTHOR=Zhang Wenyuan , Fu Fangwang , Zhan Zhenxiang 

TITLE=Association between intracranial and extracranial atherosclerosis and white matter hyperintensities: a systematic review and meta-analysis

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=15

YEAR=2024

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2023.1240509

DOI=10.3389/fnagi.2023.1240509

ISSN=1663-4365

ABSTRACT=<sec id="sec1"><title>Background</title><p>White matter hyperintensities (WMHs) are key neuroimaging markers of cerebral small vessel diseases. This study aimed to investigate whether intracranial and extracranial atherosclerotic stenosis is associated with WMHs.</p></sec><sec id="sec2"><title>Methods</title><p>Following a previously registered protocol (PROSPERO protocol: CRD42023407465), PubMed, Web of Science, and Embase were systematically searched for relevant literature published until March 2023. Cross-sectional studies examining the association between intracranial and extracranial atherosclerotic stenosis and WMHs were included. Random effects models were used to calculate the pooled estimates.</p></sec><sec id="sec3"><title>Results</title><p>Twenty-one eligible studies, including 10,841 participants, were identified. Intracranial and extracranial atherosclerotic stenosis was associated with an increased risk of WMHs (OR 1.80, 95% CI 1.25–2.57, <italic>I</italic><sup>2</sup> = 75%) and increased WMH volumes (SMD 0.40, 95% CI 0.18–0.63, <italic>I</italic><sup>2</sup> = 63%). Heterogeneity resulted from the WMHs rating method and the location. Extracranial atherosclerotic stenosis (ECAS) was significantly associated with WMHs (OR 2.10, 95% CI 1.22–3.62, <italic>I</italic><sup>2</sup> = 71%), but intracranial atherosclerotic stenosis (ICAS) was insignificantly associated with WMHs (OR 1.75, 95% CI 0.97–3.15, <italic>I</italic><sup>2</sup> = 84%). The association was stable in the subgroup analysis based on WMHs location, which included deep WMHs and periventricular WMHs.</p></sec><sec id="sec4"><title>Conclusion</title><p>Intracranial and extracranial atherosclerotic stenosis is associated with WMHs. This association is significant in ECAS, but attenuated in ICAS.</p></sec>