{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T05:38:14Z","timestamp":1792647494668,"version":"4.5.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">In this multicenter cross\u2010sectional 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Compared with controls, patients with\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">CASO<\/jats:styled-content>\n                      showed lower vessel length density across retinal layers and greater\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">WMH<\/jats:styled-content>\n                      burden. Within the group with\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">CASO<\/jats:styled-content>\n                      , the retina ipsilateral to the stenosis showed lower vessel length density and greater vessel dilation, paralleling the greater burden of deep\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">WMH<\/jats:styled-content>\n                      in the ipsilateral hemisphere (all adjusted\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.05). Retinal microvascular abnormalities and greater\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">WMH<\/jats:styled-content>\n                      burden were both associated with worse concurrent cognitive performance. Adding\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">optical coherence tomography angiography<\/jats:styled-content>\n                      metrics to clinical and\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">WMH<\/jats:styled-content>\n                      \u2010based models provided modest additional discrimination for identifying concurrent cognitive impairment in internal cross\u2010validation, increasing the\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">area under the curve<\/jats:styled-content>\n                      from 0.652 to 0.695 (\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">\u0394area under the curve<\/jats:styled-content>\n                      , 0.043 [95%\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">CI<\/jats:styled-content>\n                      , 0.021\u20130.064]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.chictr.org.cn\/\">https:\/\/www.chictr.org.cn\/<\/jats:ext-link>\n                      . Unique identifier: ChiCTR2300074640.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.126.051820","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:05:51Z","timestamp":1791633951000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Retinal Microvascular Abnormalities, White Matter Injury, and Cognitive Impairment in Carotid Stenosis or Occlusion"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0414-9932","authenticated-orcid":false,"given":"Le","family":"Cao","sequence":"first","affiliation":[{"name":"Sichuan University","place":["Chengdu, China"]},{"name":"Chinese Academy of Sciences","place":["Zhejiang, 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