Cognitive Function After Carotid Endarterectomy: Early Decline and Later Recovery
Hua-Ping Zhang1, Xiao-Dong Ma, Li-Feng Chen
1The Chinese PLA General Hospital, Department of Neurosurgery, Haidian District, Beijing, China.
Insights
Carotid endarterectomy (CEA) temporarily reduces cognitive function, with scores improving by 3 months post-surgery. Cognitive decline after CEA may relate to blood flow changes, not microemboli.
Area of Science:
- Neurology
- Vascular Surgery
- Cognitive Science
Background:
- Carotid endarterectomy (CEA) is a common procedure for carotid artery stenosis.
- Neurocognitive outcomes after CEA require further investigation, considering potential confounding factors.
Purpose of the Study:
- To prospectively evaluate neurocognitive performance after CEA.
- To identify factors influencing cognitive changes at different postoperative intervals.
Main Methods:
- 36 patients undergoing CEA (Group A) and 31 controls (Group B) were studied.
- Neuropsychological tests (MMSE, CDT) and brain MRI with DWI were performed preoperatively, 3 days, and 3 months post-surgery.
Main Results:
- No cerebral ischemia was detected by DWI post-CEA.
- Cognitive scores (MMSE, CDT) significantly decreased within 3 days after CEA but returned to baseline by 3 months.
- Higher ICA stenosis degree and clamping duration correlated with immediate postoperative cognitive impairment.
Conclusions:
- CEA is associated with early, transient cognitive decline.
- Cognitive function recovers by 3 months post-CEA.
- Early cognitive impairment may stem from intraoperative hypoperfusion/postoperative hyperperfusion rather than microemboli.
Aim:
To prospectively study neurocognitive performance following carotid endarterectomy (CEA) in various follow-up periods, taking into account the potential confounding factors.
Material And Methods:
Thirty-six patients with carotid artery stenosis received CEA (group A). Thirty-one patients underwent surgery for femoropopliteal occlusive disease served as controls (group B). Neuropsychological testing and brain magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was repeated preoperatively, within 3 days and at 3 months after surgery.
Results:
No patient had DWI evidence of procedure-related cerebral ischemia. Preoperative baseline scores of groups A and B were not statistically different in mini mental state examination (MMSE) or clock drawing task (CDT) score. MMSE and CDT scores were significantly reduced for patients in group A (p < 0.01) within 3 days after CEA. Differences of MMSE score (p=0.48) and CDT score (p=0.26) between baseline and 3 months after surgery in group A were not statistically significant. No statistically significant change of MMSE score and CDT score in group B was observed at 3 days and 3 months after the surgery. Degree of internal carotid artery (ICA) stenosis (p=0.029) and duration of ICA clamping (p=0.031) were significantly higher in patients with cognitive impairment immediately after CEA than in those without that.
Conclusion:
Our study demonstrated cognitive decline for the patients with unilateral carotid stenosis at early stage after CEA and a restorative effect at 3 months after CEA. Postoperative early cognitive impairment might be associated with intraoperative temporary hypoperfusion and postoperative hyperperfusion, not the microembolic event.
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