Retinal Microvascular Abnormalities, White Matter Injury, and Cognitive Impairment in Carotid Stenosis or Occlusion
- 1Sichuan University
- 2Chinese Academy of Sciences
- 3Capital Medical University
Abstract
BACKGROUND: Severe carotid artery stenosis or occlusion (CASO) is associated with white matter injury and cognitive impairment, but markers of accompanying microvascular dysfunction remain incompletely characterized. We investigated the relationships among retinal microvascular abnormalities on optical coherence tomography angiography, white matter hyperintensities (WMH), and cognitive impairment in severe unilateral CASO. METHODS: In this multicenter cross-sectional study, 860 participants were included: 566 patients with severe unilateral CASO without acute cerebral infarction and 294 control participants with similar age and sex distributions. All participants underwent multimodal imaging, including automated WMH segmentation on brain magnetic resonance imaging and macular optical coherence tomography angiography. Cognitive function was assessed using the Montreal Cognitive Assessment. RESULTS: <0.05). Retinal microvascular abnormalities and greater WMH burden were both associated with worse concurrent cognitive performance. Adding optical coherence tomography angiography metrics to clinical and WMH-based models provided modest additional discrimination for identifying concurrent cognitive impairment in internal cross-validation, increasing the area under the curve from 0.652 to 0.695 (Δarea under the curve, 0.043 [95% CI, 0.021-0.064]). CONCLUSIONS: In severe unilateral CASO, retinal microvascular abnormalities were associated with ipsilateral white matter injury and lower cognitive performance. Optical coherence tomography angiographymetrics provided modest complementary discriminatory information beyond conventional clinical variables and WMH for identifying concurrent cognitive impairment, although external validation is required. REGISTRATION: URL: https://www.chictr.org.cn/. Unique identifier: ChiCTR2300074640.
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BibTeX
@article{cao2026retinal,
title = {{Retinal Microvascular Abnormalities, White Matter Injury, and Cognitive Impairment in Carotid Stenosis or Occlusion}},
author = {Le Cao and Yaqi Chen and Hang Wang and William Robert Kwapong and Shijia Zhou and Tianxiang Lan and Ruishan Liu and Ruosu Pan and Yuying Yan and Wendan Tao and Guina Liu and Yitian Zhao and Bo Wu},
journal = {Journal of the American Heart Association},
year = {2026},
month = oct,
doi = {10.1161/jaha.126.051820},
url = {https://www.ahajournals.org/doi/10.1161/JAHA.126.051820},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Retinal Microvascular Abnormalities, White Matter Injury, and Cognitive Impairment in Carotid Stenosis or Occlusion
AU - Le Cao
AU - Yaqi Chen
AU - Hang Wang
AU - William Robert Kwapong
AU - Shijia Zhou
AU - Tianxiang Lan
AU - Ruishan Liu
AU - Ruosu Pan
AU - Yuying Yan
AU - Wendan Tao
AU - Guina Liu
AU - Yitian Zhao
AU - Bo Wu
PY - 2026
DA - 2026/10/20
JO - Journal of the American Heart Association
DO - 10.1161/jaha.126.051820
UR - https://www.ahajournals.org/doi/10.1161/JAHA.126.051820
AB - BACKGROUND: Severe carotid artery stenosis or occlusion (CASO) is associated with white matter injury and cognitive impairment, but markers of accompanying microvascular dysfunction remain incompletely characterized. We investigated the relationships among retinal microvascular abnormalities on optical coherence tomography angiography, white matter hyperintensities (WMH), and cognitive impairment in severe unilateral CASO. METHODS: In this multicenter cross-sectional study, 860 participants were included: 566 patients with severe unilateral CASO without acute cerebral infarction and 294 control participants with similar age and sex distributions. All participants underwent multimodal imaging, including automated WMH segmentation on brain magnetic resonance imaging and macular optical coherence tomography angiography. Cognitive function was assessed using the Montreal Cognitive Assessment. RESULTS: <0.05). Retinal microvascular abnormalities and greater WMH burden were both associated with worse concurrent cognitive performance. Adding optical coherence tomography angiography metrics to clinical and WMH-based models provided modest additional discrimination for identifying concurrent cognitive impairment in internal cross-validation, increasing the area under the curve from 0.652 to 0.695 (Δarea under the curve, 0.043 [95% CI, 0.021-0.064]). CONCLUSIONS: In severe unilateral CASO, retinal microvascular abnormalities were associated with ipsilateral white matter injury and lower cognitive performance. Optical coherence tomography angiographymetrics provided modest complementary discriminatory information beyond conventional clinical variables and WMH for identifying concurrent cognitive impairment, although external validation is required. REGISTRATION: URL: https://www.chictr.org.cn/. Unique identifier: ChiCTR2300074640.
SN - 2047-9980
ER -