Cognition after carotid endarterectomy or stenting: a randomized comparison

Area of Science:

• Neurology
• Interventional Cardiology
• Neurosurgery

Background:

• Symptomatic carotid artery stenosis poses a risk of stroke.
• Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are revascularization procedures to mitigate this risk.
• The comparative effects of CAS and CEA on cognitive function remain an area of investigation.

Purpose of the Study:

• To compare the impact of CAS versus CEA on cognitive function in patients with symptomatic carotid artery stenosis.
• To assess the incidence of new ischemic brain lesions following CAS and CEA.

Main Methods:

• A substudy of the International Carotid Stenting Study (ICSS) involving 140 patients with detailed neuropsychological examinations (NPE) before and 6 months after revascularization.
• Diffusion-weighted imaging was used to detect ischemic brain lesions within 3 days post-revascularization.
• Cognitive test results were standardized into z scores to calculate a cognitive sumscore for primary outcome analysis.

Main Results:

• While CAS was associated with a greater decrease in cognition than CEA, the difference was not statistically significant (p = 0.092).
• New ischemic brain lesions were detected significantly more often after CAS compared to CEA (RR 2.1, p = 0.041).
• Of 120 patients with follow-up NPE, 64 had post-revascularization MRI, revealing a higher lesion rate in the CAS group.

Conclusions:

• The study found no statistically significant difference in cognitive outcomes between CAS and CEA at 6 months.
• Despite similar cognitive effects, CAS was associated with a substantially higher rate of new ischemic lesions.
• Class III evidence suggests any cognitive difference between CAS and CEA is small.