title: Carotid Arterial Hemodynamic in Ischemic Levkoaraiosis Suggests Hypoperfusion Mechanism.
abstract: BACKGROUND
  Leukoaraiosis (ILA) is believed to be ischaemic in origin due to its similar location as that of lacunar infarctions and its association with cerebrovascular risk factors. However, its pathophysiology is not well understood. The ischaemic injuries may be a result of increased pulsatility or cerebral hypo-perfusion. We used carotid duplex ultrasound to prove that the underlying mechanism is hypo-perfusion.
  
  
  METHODS
  We compared 55 ILA patients to 44 risk factor-matched controls with normal magnetic resonance imaging (MRI) of the head. ILA diagnosis was based on MRI and was further categorised according to the Fazekas scale. We measured carotid artery blood flow velocity and diameter and calculated carotid blood flow and resistance indexes.
  
  
  RESULTS
  Blood flow velocities and blood flows were significantly lower in the ILA group, including diastolic, systolic and mean pressures (p ≤ 0.05). The resistance indices were higher in the ILA group, but the differences were not statistically significant. All the velocities and blood flows showed a decreasing trend with higher Fazekas score, whereas resistance indexes showed an increasing trend.
  
  
  CONCLUSIONS
  Lower blood flow and higher resistance of carotid arteries are consistent with the hypo-perfusion theory of ILA. Carotid ultrasound could have a diagnostic and prognostic role in ILA patients.
authors.affiliation: Department of Vascular Neurology and Intensive Neurological Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Monika
authors.initials: M
authors.lastname: Turk
authors.forename: Matija
authors.initials: M
authors.lastname: Zupan
authors.forename: Marjan
authors.initials: M
authors.lastname: Zaletel
authors.forename: Bojana
authors.initials: B
authors.lastname: Žvan
authors.forename: Janja
authors.initials: J
authors.lastname: Pretnar Oblak
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D049292:Leukoaraiosis / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D018616:Ultrasonography, Doppler, Duplex