Cognitive changes after surgery vs stenting for carotid artery stenosis

Area of Science:

• Neurology
• Vascular Surgery
• Cognitive Science

Background:

• Cognitive decline can be a consequence of carotid endarterectomy (CEA) or carotid artery stenting (CAS) due to microembolization or hypoperfusion.
• Carotid revascularization may potentially improve cognitive dysfunction linked to chronic hypoperfusion.

Purpose of the Study:

• To systematically compare cognitive outcomes in asymptomatic patients undergoing either CEA or CAS.
• To evaluate the impact of revascularization on various cognitive domains.

Main Methods:

• Prospective, nonrandomized, single-center study of 46 patients with asymptomatic carotid stenosis (≥70%).
• Cognitive function assessed using a comprehensive battery of tests 1-3 days pre-procedure and 4-6 months post-procedure.
• Primary analysis focused on normalized cognitive change scores and composite cognitive scores (CCS).

Main Results:

• Both CEA and CAS led to overall improvements in cognitive function, with no significant difference in composite cognitive scores between the two procedures.
• CEA showed a decrease in working memory index scores for most patients.
• CAS resulted in a decrease in processing speed index scores for most patients.

Conclusions:

• Carotid revascularization generally enhances cognitive function.
• While composite cognitive scores are similar between CEA and CAS, specific cognitive domains are affected differently by each procedure.
• Larger studies are warranted to validate these findings regarding cognitive outcomes after CEA versus CAS.