{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:52:09Z","timestamp":1791276729104,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018818","name":"National Research, Development and Innovation Office","doi-asserted-by":"publisher","award":["NKFI-PD23 146299"],"award-info":[{"award-number":["NKFI-PD23 146299"]}],"id":[{"id":"10.13039\/501100018818","id-type":"DOI","asserted-by":"publisher"}]},{"award":["NKFI-PD23 146299"],"award-info":[{"award-number":["NKFI-PD23 146299"]}],"id":[{"id":"https:\/\/ror.org\/03g2am276","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>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 \u00b1 7 years, 37.9% were female, significant contralateral stenosis was present in four cases, and the average exclusion time was 30.1 \u00b1 9.7 min. In multivariable regression, a higher contralateral Fazekas score was independently associated with greater contralateral rSO2 desaturation during carotid clamping (unstandardized \u03b2 = 0.008, standardized \u03b2 = 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.<\/jats:p>","DOI":"10.3390\/diagnostics16193212","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:02:27Z","timestamp":1791194547000},"page":"3212","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative White Matter Disease Severity Predicts Intraoperative Cerebral Desaturation During Carotid Endarterectomy"],"prefix":"10.3390","volume":"16","author":[{"given":"M\u00e1rk","family":"Matus","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9419-7067","authenticated-orcid":false,"given":"\u00c1gnes D\u00f3ra","family":"S\u00e1ndor","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6049-4171","authenticated-orcid":false,"given":"Olaf Aleksander","family":"Zi\u00f3\u0142kiewicz","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa Pawin-On","family":"Brinning","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Varga","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Semmelweis University, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"S\u00f3tonyi","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Magyar-Stang","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary"},{"name":"Department of Neurology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0886-3674","authenticated-orcid":false,"given":"Zsuzsanna","family":"Mih\u00e1ly","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1016\/S1474-4422(13)70135-2","article-title":"Effect of white-matter lesions on the risk of periprocedural stroke after carotid artery stenting versus endarterectomy in the International Carotid Stenting Study (ICSS): A prespecified analysis of data from a randomised trial","volume":"12","author":"Ederle","year":"2013","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/S0741-5214(98)70363-5","article-title":"Incidence, timing, and causes of cerebral ischemia during carotid endarterectomy with regional anesthesia","volume":"27","author":"Lawrence","year":"1998","journal-title":"J. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1002\/ana.27136","article-title":"SVDs@target Consortium. Cerebrovascular function in sporadic and genetic cerebral small vessel disease","volume":"97","author":"Stringer","year":"2025","journal-title":"Ann. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2776","DOI":"10.1161\/STROKEAHA.123.042656","article-title":"Cerebrovascular reactivity in patients with small vessel disease: A cross-sectional study","volume":"54","author":"Sleight","year":"2023","journal-title":"Stroke"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.ejvs.2017.02.033","article-title":"Near infrared spectroscopy as a predictor for shunt requirement during carotid endarterectomy","volume":"53","author":"Jonsson","year":"2017","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Lengyel, B., Magyar-Stang, R., P\u00e1l, H., Debreczeni, R., S\u00e1ndor, \u00c1.D., Sz\u00e9kely, A., Gy\u00fcrki, D., Csippa, B., Istv\u00e1n, L., and Kov\u00e1cs, I. (2024). Non-invasive tools in perioperative stroke risk assessment for asymptomatic carotid artery stenosis with a focus on the Circle of Willis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13092487"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/S1474-4422(19)30079-1","article-title":"Small vessel disease: Mechanisms and clinical implications","volume":"18","author":"Wardlaw","year":"2019","journal-title":"Lancet Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e213619","DOI":"10.1212\/WNL.0000000000213619","article-title":"ESCAPE-NA1 Investigators. Impact of brain frailty on clinical presentation and neurologic recovery in acute ischemic stroke patients undergoing thrombectomy","volume":"104","author":"Fladt","year":"2025","journal-title":"Neurology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e2534941","DOI":"10.1001\/jamanetworkopen.2025.34941","article-title":"Brain frailty and functional outcomes after thrombolysis for acute ischemic stroke","volume":"8","author":"Loewen","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1148\/radiol.2491071644","article-title":"Reduced cerebrovascular reserve at CO2 BOLD MR imaging is associated with increased risk of periinterventional ischemic lesions during carotid endarterectomy or stent placement: Preliminary results","volume":"249","author":"Haller","year":"2008","journal-title":"Radiology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1053\/j.jvca.2016.10.017","article-title":"Brain oxygen supply parameters in the risk assessment of cerebral complications during carotid endarterectomy","volume":"31","author":"Kamenskaya","year":"2017","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1016\/j.avsg.2025.10.016","article-title":"Near infrared spectroscopy versus stump pressure in detecting cerebral ischemia during carotid endarterectomy: A prospective multicenter observational study","volume":"123","author":"Lindberg","year":"2026","journal-title":"Ann. Vasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.avsg.2021.06.044","article-title":"Intraoperative cerebral monitoring during carotid surgery: A narrative review","volume":"78","author":"Bozzani","year":"2022","journal-title":"Ann. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.ejvs.2021.08.022","article-title":"Overview and diagnostic accuracy of near infrared spectroscopy in carotid endarterectomy: A systematic review and meta-analysis","volume":"62","author":"Khan","year":"2021","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.neurobiolaging.2024.03.006","article-title":"Older Adults with Reduced Cerebrovascular Reactivity Exhibit High White Matter Hyperintensity Burden","volume":"139","author":"Kapoor","year":"2024","journal-title":"Neurobiol. Aging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e2258","DOI":"10.1212\/WNL.0000000000009483","article-title":"Intracranial Hemodynamic Relationships in Patients with Cerebral Small Vessel Disease","volume":"94","author":"Blair","year":"2020","journal-title":"Neurology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1002\/ana.24712","article-title":"Development of White Matter Hyperintensity Is Preceded by Reduced Cerebrovascular Reactivity","volume":"80","author":"Sam","year":"2016","journal-title":"Ann. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2301","DOI":"10.1177\/0271678X251366079","article-title":"Retinal Vascular Reactivity Is Associated with White Matter Hyperintensities and Dysfunctional Cerebrovascular Reactivity in Cerebral Small Vessel Disease","volume":"45","author":"Blair","year":"2025","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/j.jvs.2024.04.052","article-title":"The Effect of the Collateral Cerebrovascular Circulation on Tolerance to Carotid Artery Cross-Clamping and on Early Outcome After Carotid Endarterectomy","volume":"80","author":"Myrcha","year":"2024","journal-title":"J. Vasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5335","DOI":"10.1007\/s10072-021-05265-4","article-title":"Study on the Correlation Between the Circle of Willis Structure and Collateral Circulation in Bilateral Carotid Artery Occlusion","volume":"42","author":"Liu","year":"2021","journal-title":"Neurol. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.wneu.2018.02.189","article-title":"Circle of Willis Collateral Flow in Carotid Artery Occlusion Is Depicted by 4D-CTA","volume":"114","author":"Meijs","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/S1474-4422(11)70195-8","article-title":"Collateral Blood Vessels in Acute Ischaemic Stroke: A Potential Therapeutic Target","volume":"10","author":"Shuaib","year":"2011","journal-title":"Lancet Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1017\/cjn.2016.10","article-title":"Circle of Willis Collateral During Temporary Internal Carotid Artery Occlusion II: Observations from Computed Tomography Angiography","volume":"43","author":"Wang","year":"2016","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2671","DOI":"10.1161\/01.STR.30.12.2671","article-title":"Circle of Willis Collateral Flow Investigated by Magnetic Resonance Angiography","volume":"30","author":"Hartkamp","year":"1999","journal-title":"Stroke"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1007\/s00701-020-04621-1","article-title":"Selective Internal Carotid Artery Cross-Clamping Increases the Specificity of Cerebral Oximetry for Indication of Shunting During Carotid Endarterectomy","volume":"163","author":"Malucelli","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1161\/STROKEAHA.119.024757","article-title":"Blood Flow Lateralization and Collateral Compensatory Mechanisms in Patients with Carotid Artery Stenosis","volume":"50","author":"Zarrinkoob","year":"2019","journal-title":"Stroke"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1152\/physrev.00022.2020","article-title":"Regulation of cerebral blood flow in humans: Physiology and clinical implications of autoregulation","volume":"101","author":"Claassen","year":"2021","journal-title":"Physiol. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"254","DOI":"10.5001\/omj.2012.59","article-title":"Prevention of Intra-operative Cerebral Ischemia during Carotid Endarterectomy, Loco-regional versus General Anesthesia","volume":"27","author":"Tawfic","year":"2012","journal-title":"Oman Med. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1080\/02699052.2025.2596227","article-title":"Cerebral oximetry and predictors of diffusion-weighted lesions after carotid endarterectomy and stenting","volume":"40","author":"Budinski","year":"2026","journal-title":"Brain Inj."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1177\/1747493019874732","article-title":"Adverse effects of pre-existing cerebral small vessel disease on cognitive improvement after carotid endarterectomy","volume":"15","author":"Yoshida","year":"2020","journal-title":"Int. J. Stroke"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1177\/0963689718817760","article-title":"The Efficacy of Near-Infrared Spectroscopy Monitoring in Carotid Endarterectomy: A Prospective, Single-Center, Observational Study","volume":"28","author":"Wang","year":"2019","journal-title":"Cell Transplant."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1007\/s00234-024-03527-4","article-title":"Temporal changes and implications of diffusion tensor imaging metrics and cerebral white matter volume in patients undergoing carotid endarterectomy\u2014A prospective study","volume":"67","author":"Varga","year":"2025","journal-title":"Neuroradiology"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/19\/3212\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:12:27Z","timestamp":1791274347000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/19\/3212"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,3]]},"references-count":32,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["diagnostics16193212"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16193212","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,3]]}}}