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Leukoaraiosis predicts the need for intraoperative shunt placement during carotid endarterectomy.

AbstractOBJECTIVES:
White matter hyperintense lesions (WMHLs) are related to age, hypertension, and ischemia. They increase the risk of stroke in natural history and perioperatively during carotid endarterectomy. This may reflect an association with impaired cerebral hemodynamics. Hence, the authors studied whether ipsilateral WMHLs predict shunt requirement on clamping as an indicator of hemodynamic compromise.
DESIGN AND METHODS:
A retrospective analysis was done in patients with symptomatic and severe carotid stenosis (>60%). Ipsilateral WMHL volumes were calculated from magnetic resonance imaging scans and association studied with the requirement of an intraoperative shunt.
RESULTS:
Seventy patients were included. Twelve (17%) patients required shunting and 2 developed perioperative strokes. Patients requiring shunting had a larger WMHL volume (adjusted means = 16.2 +/- 2.9 mL compared with 8.7 +/- 1.2 mL for the nonshunt group; P = .020).
CONCLUSIONS:
Ipsilateral WMHL volume is a significant predictive factor for shunt requirement during carotid endarterectomy. This may reflect cerebral hemodynamic compromise.
AuthorsAli Arshad, Nishath Altaf, Stephen Goode, Dorothee P Auer, Shane T MacSweeney
JournalPerspectives in vascular surgery and endovascular therapy (Perspect Vasc Surg Endovasc Ther) Vol. 21 Issue 3 Pg. 173-7 (Sep 2009) ISSN: 1521-5768 [Electronic] United States
PMID19819913 (Publication Type: Journal Article)
Topics
  • Aged
  • Aged, 80 and over
  • Carotid Stenosis (complications, pathology, physiopathology, surgery)
  • Cerebrovascular Circulation
  • Collateral Circulation
  • Constriction
  • Endarterectomy, Carotid (adverse effects)
  • Female
  • Hemodynamics
  • Humans
  • Leukoaraiosis (etiology, pathology, physiopathology)
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Perfusion
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Stroke (etiology, pathology, physiopathology)
  • Treatment Outcome

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