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A Mouse Model for Vascular Cognitive Impairment and Dementia Based on Needle-guided Asymmetric Bilateral Common Carotid Artery Stenosis
Published on: November 22, 2024
Is Hemispheric Hypoperfusion a Treatable Cause of Cognitive Impairment?
Amani M Norling1, Randolph S Marshall2, Marykay A Pavol2
1Department of Neurology, University of Alabama at Birmingham, 1720 7th Ave S-SC 650, Birmingham, AL, 35294, USA.
Insights
Severe carotid artery stenosis may cause reversible vascular cognitive impairment. Revascularization treatments like carotid endarterectomy and stenting show promise for improving cognitive function in affected patients.
Area of Science:
- Neurology
- Vascular Surgery
- Cognitive Science
Background:
- Internal carotid artery stenosis can lead to reduced cerebral blood flow.
- Cerebral hemodynamic compromise is increasingly recognized as a potential contributor to vascular cognitive impairment.
- Revascularization strategies are being explored as treatments for cognitive decline linked to carotid artery disease.
Purpose of the Study:
- To review literature supporting cerebral hemodynamic compromise from internal carotid artery stenosis as a cause of vascular cognitive impairment.
- To evaluate the potential for revascularization to treat this condition.
Main Methods:
- Literature review of studies investigating carotid artery stenosis and cognitive function.
- Analysis of findings from cohort studies and comparisons with control groups.
- Consideration of factors influencing treatment benefit, such as patient heterogeneity and confounding variables.
Main Results:
- Evidence suggests carotid endarterectomy and stenting can reverse cognitive decline in some patients with severe asymptomatic carotid artery stenosis.
- Treatment benefits may be obscured by patient heterogeneity, confounding conditions (e.g., heart failure), or inadequate assessment of hemodynamic failure.
- Patients with severe stenosis and hemodynamic impairment may experience reversible cognitive decline.
Conclusions:
- Severe carotid artery stenosis causing hemodynamic impairment presents a potentially reversible cause of cognitive decline.
- Further research, including large randomized trials like CREST-2 and CREST-H, is needed to definitively establish the benefits of revascularization for cognitive impairment.
Purpose Of Review:
To review the current literature that supports the notion that cerebral hemodynamic compromise from internal carotid artery stenosis may be a cause of vascular cognitive impairment that is amenable to treatment by revascularization.
Recent Findings:
Converging evidence suggests that successful carotid endarterectomy and carotid artery stenting are associated with reversal of cognitive decline in many patients with severe but asymptomatic carotid artery stenosis. Most of these findings have been derived from cohort studies and comparisons with either normal or surgical controls. Failure to find treatment benefit in a number of studies appears to have been the result of patient heterogeneity or confounding from concomitant conditions independently associated with cognitive decline, such as heart failure and other cardiovascular risk factors, or failure to establish pre-procedure hemodynamic failure. Patients with severe carotid artery stenosis causing cerebral hemodynamic impairment may have a reversible cause of cognitive decline. None of the prior studies, however, were done in the context of a randomized clinical trial with large numbers of participants. The ongoing CREST-2 trial comparing revascularization with medical therapy versus medical therapy alone, and its associated CREST-H study determining whether cognitive decline is reversible among those with hemodynamic compromise may address this question.
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