Association of intracranial atherosclerotic stenosis with severity of white matter hyperintensities

Background and purpose White matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) have been linked to small‐vessel disease, but the precise pathogenesis underlying WMHs remains unclear. Studies about an association of WMHs with extracranial atherosclerotic stenosis (ECAS) showed conflicting results and the relationship of WMHs with intracranial atherosclerotic stenosis (ICAS) is uncertain. Methods A cross‐sectional study of 679 consecutive Korean patients with acute ischaemic stroke (mean age 67.8 ± 12.6; 395 males) who underwent brain MRI/MR angiography was conducted. Severity of deep WMHs (d‐WMHs, n = 560) and periventricular WMHs (p‐WMHs, n = 590) was rated separately and compared across three groups: ICAS (n = 318), ECAS (n = 71) and no cerebral atherosclerotic stenosis (NCAS) (n = 290). Results The ICAS group showed a higher d‐WMH/p‐WMH score (1.62 ± 0.85/1.65 ± 0.79) than both the ECAS (1.25 ± 0.87/1.23 ± 0.78) and NCAS (1.19 ± 0.92/1.24 ± 0.81) groups (P