Document Detail

Leukoaraiosis predicts the need for intraoperative shunt placement during carotid endarterectomy.
MedLine Citation:
PMID:  19819913     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: 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.
Ali Arshad; Nishath Altaf; Stephen Goode; Dorothee P Auer; Shane T MacSweeney
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Publication Detail:
Type:  Journal Article     Date:  2009-10-09
Journal Detail:
Title:  Perspectives in vascular surgery and endovascular therapy     Volume:  21     ISSN:  1521-5768     ISO Abbreviation:  Perspect Vasc Surg Endovasc Ther     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-12-23     Completed Date:  2010-03-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100970607     Medline TA:  Perspect Vasc Surg Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  173-7     Citation Subset:  IM    
Department of Vascular and Endovascular Surgery, University Hospitals, Nottingham, UK.
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MeSH Terms
Aged, 80 and over
Carotid Stenosis / complications,  pathology,  physiopathology,  surgery*
Cerebrovascular Circulation*
Collateral Circulation
Endarterectomy, Carotid / adverse effects*
Leukoaraiosis / etiology*,  pathology,  physiopathology
Magnetic Resonance Imaging
Middle Aged
Retrospective Studies
Risk Assessment
Severity of Illness Index
Stroke / etiology*,  pathology,  physiopathology
Treatment Outcome
Comment In:
Perspect Vasc Surg Endovasc Ther. 2009 Sep;21(3):179-80   [PMID:  19965790 ]
Perspect Vasc Surg Endovasc Ther. 2009 Sep;21(3):178, 180   [PMID:  19965789 ]

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