Changes in Cognition and Hemodynamics 1 Year after Carotid Endarterectomy for Asymptomatic Stenosis
Petr Košťál1,2, Tomáš Mrhálek3, Alena Kajanová4
1Department of Neurosurgery, Hospital České Budějovice, České Budějovice, Czech Republic.
Insights
Carotid endarterectomy (CEA) for asymptomatic carotid stenosis (ACS) improved immediate memory and visuospatial skills. Changes in cerebral artery blood flow correlated with specific cognitive improvements, though speech index declined.
Area of Science:
- Neurology
- Vascular Surgery
- Cognitive Neuroscience
Background:
- The impact of hemodynamic changes on cognitive function post-carotid endarterectomy (CEA) for asymptomatic carotid stenosis (ACS) is not well-understood.
- Assessing cognitive efficiency alongside cerebral blood flow changes after CEA is crucial for understanding neurological outcomes.
Purpose of the Study:
- To evaluate the 1-year outcomes of CEA for ACS by examining changes in cerebral artery blood flow and cognitive efficiency.
- To determine the correlation between hemodynamic changes in the anterior, middle, and posterior cerebral arteries and cognitive skill improvements post-CEA.
Main Methods:
- Quantitative magnetic resonance angiography measured cerebral artery flow volume in 19 patients (14 males, 5 females) before and 1 year after CEA.
- Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).
- Flow volume data were analyzed using simple ratio (SR) and covariance with cognitive changes.
Main Results:
- Significant improvements were observed in immediate memory and visuospatial perception at 1 year post-CEA.
- A significant decline in the speech index was noted.
- Middle cerebral artery (MCA) flow showed the strongest correlation with visuospatial perception; posterior cerebral artery (PCA) flow with immediate memory; and anterior cerebral artery (ACA) flow with the speech index.
Conclusions:
- The study suggests an association between revascularization via CEA and cognitive improvements in ACS patients.
- Improvements in visuospatial perception, immediate memory, and speech were linked to specific cerebral artery flow changes (MCA, PCA, ACA, respectively).
- Limitations due to small sample size necessitate larger studies to confirm these hemodynamic-cognitive associations in CEA patients.
Objectives:
The impact of a change in hemodynamics on cognitive skills in patients with asymptomatic carotid stenosis (ACS) after carotid endarterectomy (CEA) remains unclear. The aim of this study was to evaluate the results of CEA for ACS at 1 year by assessing the changes in anterior, middle, and posterior cerebral artery blood flow in tandem with changes in cognitive efficiency.
Methods:
Flow volume in cerebral arteries using quantitative magnetic resonance angiography was measured in a group of 14 males and 5 females before and at 1 year after CEA for ACS. Cognitive efficiency was assessed by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The values of flow volume were processed using simple ratio (SR) and were used for covariance analyses with changes in cognitive skills after CEA.
Results:
A significant improvement in cognitive efficiency indexes of immediate memory and visuospatial perception at 1 year after CEA for ACS was observed. Simultaneously, a significant deterioration of speech index was noted. During the analysis of association between flow and cognition, the highest correlation could be seen between the middle cerebral artery (MCA) flow and the visuospatial perception. A change in posterior cerebral artery (PCA) flow was associated with an increase in immediate memory index and anterior cerebral artery (ACA) flow change with the speech index.
Conclusion:
Convergence of data supporting the association between revascularization and cognitive improvement were added in a small, single-center cohort of ACS patients undergoing CEA. No significant differences in cognition were seen between preoperative findings and at 1 year after CEA. Visuospatial perception improvement was linked to flow change in MCA, immediate memory improvement to flow change in PCA, and speech index change to flow change in ACA. Methodical limitations of this small study preclude formulating larger generalizations. Hemodynamic factors in CEA should be assessed in a larger-scale study.
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