Microembolization is associated with transient cognitive decline in patients undergoing carotid interventions

Area of Science:

• Neurology
• Interventional Cardiology
• Neuropsychology

Background:

• Carotid interventions reduce stroke risk in high-grade stenosis.
• Subclinical cerebral microemboli (SCME) can occur during these procedures.
• SCME are linked to postoperative memory decline.

Purpose of the Study:

• To determine if cognitive decline after carotid interventions persists long-term.
• To assess changes in multiple cognitive domains post-intervention.
• To investigate the relationship between microembolization and cognitive changes.

Main Methods:

• Prospective recruitment of 80 male patients undergoing carotid stenting or endarterectomy.
• Neuropsychological testing preoperatively and at 1 and 6 months postoperatively.
• Diffusion-weighted MRI to detect microemboli within 48 hours of intervention.

Main Results:

• 56% of patients had new postoperative microemboli, more common in stenting (P < .005).
• Microembolization predicted short-term decline in verbal memory and executive function (Trail Making A).
• At 6 months, age and COPD predicted cognitive decline, independent of emboli.

Conclusions:

• Microembolization predicts short-term cognitive decline following carotid interventions.
• Some cognitive deficits persist at 6 months post-intervention.
• Further research is needed to identify individual patient risk factors for cognitive recovery.