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White matter hyperintensities and their subtypes in patients with carotid artery stenosis: a systematic review and meta-analysis
  1. Huirong Ye1,
  2. Yujie Wang1,
  3. Jianting Qiu1,
  4. Qing Wu2,
  5. Mengmeng Xu2,
  6. Jian Wang1
  1. 1 Department of Neurology, Cerebrovascular Disease Center, People’s Hospital, China Medical University, Shenyang, People’s Republic of China
  2. 2 Department of Neurology, Dalian Medical University, Dalian, People’s Republic of China
  1. Correspondence to Dr Yujie Wang; wangyujie196508{at}163.com

Abstract

Objective We aimed to perform a systematic review and meta-analysis to clarify the association between white matter hyperintensities (WMHs) and carotid artery (CA) stenosis.

Study design Systematic review and meta-analysis.

Participants CA stenosis was set at ≥50%, and WMHs were assessed by MRI and evaluated quantitatively or semiquantitatively.

Data sources A comprehensive literature search was performed in PubMed, EMBASE and Cochrane Library for studies evaluating the association between WMHs and CA stenosis ≥50% from inception to 13 September 2017.

Main outcomes and measures Standardised mean difference (SMD) with 95% CI was used to evaluate the association between WMHs and CA stenosis. Results were presented in a forest plot with a fixed-effects model or random-effects model. We assessed the quality of included studies using the Newcastle-Ottawa Scale. Funnel plots and Egger’s and Begg’s tests were conducted to assess publication bias. Sensitivity analysis was performed to evaluate the influence of each individual study.

Results Eight studies enrolling 677 patients were included. There was a positive relationship between the total WMHs and CA stenosis, with a pooled fixed-effects SMD of 0.326 (95% CI 0.194 to 0.459, p=0.000). Heterogeneity and publication bias were low among these studies. Subgroup analysis of three studies enrolling 225 patients showed an association between periventricular WMHs and CA stenosis, with a pooled fixed-effects SMD of 0.412 (95% CI 0.202 to 0.622, p=0.000).

Conclusion This meta-analysis showed that the total WMHs and periventricular WMHs were associated with CA stenosis. WMHs may be considered as an individual risk stratification score when choosing a proper plan for therapy of CA stenosis.

  • systematic review
  • meta-analysis
  • white matter hyperintensities
  • carotid artery stenosis
  • magnetic resonance imaging

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • HY and YW contributed equally.

  • Contributors HY and YW have contributed to the design and concept of the manuscript. Others have contributed to writing and revision of the paper. YW: study concept and design, acquisition of data, analysis and interpretation of data, manuscript drafting. HY: study concept and design, acquisition of data, analysis and interpretation of data, manuscript drafting. JQ: acquisition of data, analysis and interpretation of data. QW: analysis and interpretation of data, critical revision of the manuscript for intellectual content. MX: analysis and interpretation of data, critical revision of the manuscript for intellectual content. JW: analysis and interpretation of data, critical revision of the manuscript for intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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