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Perioperative microembolism is not associated with cognitive outcome three months after carotid endarterectomy
E R Bossema1, N Brand, F L Moll
1Department of Health Psychology, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands. e.r.bossema@fss.uu.nl
Objective:
To investigate the association between perioperative microembolism and cognitive outcome 3 months after carotid endarterectomy (CEA).
Design:
Prospective study.
Materials And Methods:
Patients were tested 1 day before and 3 months after surgery with neuropsychological tests measuring a wide range of cognitive functions. Number of microemboli was monitored with transcranial Doppler ultrasonography in 58 patients during the operation and in a random subgroup of 27 patients directly following the procedure.
Results:
Forty patients (69%) had intraoperative embolism, varying from 1 to 33 isolated microemboli and/or 1 to 11 embolic showers. Postoperative emboli were present in 22 of the 27 patients (81%), ranging from 1 to 142 isolated microemboli. More than 10 microemboli (including showers) were detected in 13 patients (22%) intraoperatively and in 6 patients (22%) postoperatively. Twenty-two patients (38%) showed deterioration in three or more cognitive function variables at 3 months. There were no significant associations between any cognitive change or deterioration score and presence or number of intraoperative and/or postoperative emboli.
Conclusions:
The degree of microembolism during and immediately following CEA is generally small and seems to be of no significance with respect to postoperative cognitive functioning. Future research should include a larger group of patients to allow reliable subgroup analysis.