title: Leukoaraiosis predicts the need for intraoperative shunt placement during carotid endarterectomy.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospitals, Nottingham, UK. ali.arshad@doctors.org.uk
authors.forename: Ali
authors.initials: A
authors.lastname: Arshad
authors.forename: Nishath
authors.initials: N
authors.lastname: Altaf
authors.forename: Stephen
authors.initials: S
authors.lastname: Goode
authors.forename: Dorothee P
authors.initials: DP
authors.lastname: Auer
authors.forename: Shane T
authors.initials: ST
authors.lastname: MacSweeney
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D003250:Constriction; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D049292:Leukoaraiosis / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D016896:Treatment Outcome