Preoperative White Matter Disease Severity Predicts Intraoperative Cerebral Desaturation During Carotid Endarterectomy.
4 affiliations
- 1Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary.
- 2Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Budapest, Hungary.
- 3Cardiovascular Center, Semmelweis University, 1122 Budapest, Hungary.
- 4Department of Neurology, Semmelweis University, 1083 Budapest, Hungary.
Abstract
Objective: Carotid endarterectomy carries the risk of cerebral ischemia during carotid clamping. Traditional risk stratification relies on anatomic factors such as contralateral stenosis, yet these predictors demonstrate limited sensitivity for intraoperative hypoperfusion. White matter hyperintensities (WMH), quantified by the Fazekas scale, reflect chronic cerebral small vessel disease and impaired cerebrovascular reactivity. Whether baseline WMH burden predicts intraoperative cerebral oxygen desaturation during carotid clamping remains unknown. Methods: This prospective, single-center cohort study enrolled patients undergoing carotid endarterectomy with continuous bilateral near-infrared spectroscopy (NIRS) monitoring. The primary outcome was the maximum contralateral regional cerebral oxygen saturation (rSO₂) decrease within 2 min after carotid clamp placement compared with the pre-clamp baseline. The primary predictor was the contralateral hemisphere Fazekas score assessed on preoperative brain MRI. Multivariable linear regression adjusted for age, contralateral carotid stenosis, clamping time, and shunt use. Results: Of 173 patients screened, 58 with complete data were included in the final analysis. Th average age was 69. 2 ± 7 years, 37.9% were female, significant contralateral stenosis was present in four cases, and the average exclusion time was 30.1 ± 9.7 min. In multivariable regression, a higher contralateral Fazekas score was independently associated with greater contralateral rSO₂ desaturation during carotid clamping (unstandardized β = 0.008, standardized β = 0.287, p = 0.035). The association remained statistically significant after adjustment for all covariates. The overall model explained 8.8% of variance in contralateral desaturation (R² = 0.088). Conclusions: Contralateral white matter disease severity, quantified by Fazekas score, was independently associated with greater contralateral cerebral oxygen desaturation during carotid clamping. This finding supports the concept that baseline microvascular disease modifies acute ischemic tolerance independent of large-vessel anatomy. Preoperative Fazekas scoring may enhance risk stratification and inform individualized neuromonitoring strategies during carotid endarterectomy.
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BibTeX
@article{matus2026preoperative,
title = {{Preoperative White Matter Disease Severity Predicts Intraoperative Cerebral Desaturation During Carotid Endarterectomy.}},
author = {Márk Matus and Ágnes Dóra Sándor and Olaf Aleksander Ziółkiewicz and Melissa Pawin-On Brinning and Andrea Varga and Péter Sótonyi and Rita Magyar-Stang and Zsuzsanna Mihály},
journal = {Diagnostics (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/diagnostics16193212},
url = {https://europepmc.org/article/MED/42882367},
note = {CC BY},
}
RIS
TY - JOUR
TI - Preoperative White Matter Disease Severity Predicts Intraoperative Cerebral Desaturation During Carotid Endarterectomy.
AU - Márk Matus
AU - Ágnes Dóra Sándor
AU - Olaf Aleksander Ziółkiewicz
AU - Melissa Pawin-On Brinning
AU - Andrea Varga
AU - Péter Sótonyi
AU - Rita Magyar-Stang
AU - Zsuzsanna Mihály
PY - 2026
DA - 2026/10/03
JO - Diagnostics (Basel, Switzerland)
DO - 10.3390/diagnostics16193212
UR - https://europepmc.org/article/MED/42882367
AB - Objective: Carotid endarterectomy carries the risk of cerebral ischemia during carotid clamping. Traditional risk stratification relies on anatomic factors such as contralateral stenosis, yet these predictors demonstrate limited sensitivity for intraoperative hypoperfusion. White matter hyperintensities (WMH), quantified by the Fazekas scale, reflect chronic cerebral small vessel disease and impaired cerebrovascular reactivity. Whether baseline WMH burden predicts intraoperative cerebral oxygen desaturation during carotid clamping remains unknown. Methods: This prospective, single-center cohort study enrolled patients undergoing carotid endarterectomy with continuous bilateral near-infrared spectroscopy (NIRS) monitoring. The primary outcome was the maximum contralateral regional cerebral oxygen saturation (rSO₂) decrease within 2 min after carotid clamp placement compared with the pre-clamp baseline. The primary predictor was the contralateral hemisphere Fazekas score assessed on preoperative brain MRI. Multivariable linear regression adjusted for age, contralateral carotid stenosis, clamping time, and shunt use. Results: Of 173 patients screened, 58 with complete data were included in the final analysis. Th average age was 69. 2 ± 7 years, 37.9% were female, significant contralateral stenosis was present in four cases, and the average exclusion time was 30.1 ± 9.7 min. In multivariable regression, a higher contralateral Fazekas score was independently associated with greater contralateral rSO₂ desaturation during carotid clamping (unstandardized β = 0.008, standardized β = 0.287, p = 0.035). The association remained statistically significant after adjustment for all covariates. The overall model explained 8.8% of variance in contralateral desaturation (R² = 0.088). Conclusions: Contralateral white matter disease severity, quantified by Fazekas score, was independently associated with greater contralateral cerebral oxygen desaturation during carotid clamping. This finding supports the concept that baseline microvascular disease modifies acute ischemic tolerance independent of large-vessel anatomy. Preoperative Fazekas scoring may enhance risk stratification and inform individualized neuromonitoring strategies during carotid endarterectomy.
SN - 2075-4418
ER -