Objective: Our aim was to investigate the relationship of carotid structure and function with MRI markers of cerebral ischemic small-vessel disease.Methods: The study comprised 1,800 participants (aged 72.5 6 4.1 years, 59.4% women) from the 3C-Dijon Study, a population-based, prospective cohort study, who had undergone quantitative brain MRI and carotid ultrasound. We used multivariable logistic and linear regression adjusted for age, sex, and vascular risk factors.Results: Presence of carotid plaque and increasing carotid lumen diameter (but not common carotid artery intima-media thickness) were associated with higher prevalence of lacunar infarcts: odds ratio ( Conclusions: In addition to and independently of carotid plaque, increasing carotid lumen diameter and markers of carotid stiffness were associated with increasing prevalence of lacunar infarcts and increasing WMHV, respectively. Neurology â 2013;80:662-669 GLOSSARY BI 5 brain infarct; CCA 5 common carotid artery; CI 5 confidence interval; IMT 5 intima-media thickness; LI 5 lacunar infarct; L-WMHV 5 large white matter hyperintensity volume; OR 5 odds ratio; SVD 5 small-vessel disease; WMH 5 white matter hyperintensity; WMHV 5 white matter hyperintensity volume.Brain imaging studies have shown that the impact of ischemic brain injury, a major cause of disability, dementia, and mortality in adults, 1 extends much beyond that of acute clinical events such as stroke. Vascular lesions, including MRI-defined brain infarcts (BIs) and white matter hyperintensities (WMH), are frequently observed in older community-dwelling individuals. The prevalence of BIs ranges between 8% and 28% 2,3