Left or right carotid endarterectomy in patients with atherosclerotic disease: ipsilateral effects on cognition?
N Brand1, E R Bossema, M van Ommen Mv
1Department of Health Psychology, Research Institute for Psychology and Health, Utrecht University, Utrecht TC, The Netherlands. n.brand@fss.uu.nl
Insights
This study found no ipsilateral cognitive improvements after carotid endarterectomy (CEA) for severe carotid artery stenosis. Cognitive function did not improve on the side of surgery, despite using valid hemispheric function tests.
Area of Science:
- Neurology
- Vascular Surgery
- Cognitive Neuroscience
Background:
- Carotid endarterectomy (CEA) is a procedure to remove plaque from carotid arteries.
- Assessing hemispheric function post-CEA is crucial for understanding cognitive outcomes.
- Severe carotid artery stenosis poses risks for stroke and cognitive impairment.
Purpose of the Study:
- To evaluate ipsilateral hemispheric functions following carotid endarterectomy (CEA).
- To determine if cognitive function improves on the side of surgery in patients with severe carotid artery stenosis.
- To investigate changes in specific cognitive domains using validated tests.
Main Methods:
- Included 36 right-handed males undergoing CEA for severe unilateral carotid stenosis.
- Assessed hemispheric functions (verbal dichotic listening, finger tapping, motor planning) 1 day before and 3 months after surgery.
- Utilized laterality and visuoconstructive tests to measure cognitive performance.
Main Results:
- Preoperatively, patients scored lower than norms on laterality and visuoconstructive tests.
- No significant ipsilateral cognitive improvement was observed related to the side of CEA.
- Left ear dichotic listening improved in both surgical groups, while motor planning speed decreased bilaterally.
Conclusions:
- Beneficial ipsilateral cognitive changes after CEA in severe carotid stenosis patients were not demonstrated.
- The study highlights the complexity of cognitive recovery after carotid revascularization.
- Further research may be needed to understand long-term cognitive effects and identify predictive factors for improvement.
Abstract:
We evaluated hemispheric functions ipsilateral to the side of carotid endarterectomy (CEA) in patients with a severe stenosis in the left or right carotid artery. Assessments took place 1 day before and 3 months after CEA. Only right-handed males were included. Nineteen patients underwent surgery of the left carotid artery and 17 of the right. Valid instruments for hemispheric function were included, such as verbal dichotic listening, finger tapping, and a lateralised test for motor planning. Results showed that, preoperatively, patients had lower scores compared to norms on the laterality tests, and on a visuoconstructive test. There was no evidence of ipsilateral improvement related to side of surgery. Left ear dichotic listening improved, which was seen in both left and right surgery groups. Also in both groups, left- and right-hand movement speed in the motor planning test decreased. Conclusion is that beneficial ipsilateral cognitive change after CEA in patients with severe stenosis in one of the carotid arteries may not be demonstrated, even if valid instruments for hemispheric function are included.
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