Evaluation of Neurocognitive Abilities in Patients Undergoing Carotid Endarterectomy Surgery

To evaluate the differences in neurocognitive abilities between the preoperative and postoperative periods following carotid endarterectomy (CEA), due to carotid artery stenosis, and to evaluate the effectiveness of CEA on neurocognitive abilities in the future.

Thirty-eight cases of CEA surgery at Bozok University Faculty of Medicine Research Hospital between January 2015 and June 2020 were examined. Neurocognitive tests were performed on carotid endarterectomy patients one day before the operation and on the 2nd, 4th, and 30th postoperative days. The effect of CEA on cognitive results has been investigated.

Of the patients, eight were female (21.1%), 30 were male (78.9%), and the mean age was 66 ± 4.09. Thirty-two (84.21%) of the patients were operated on under general anesthesia and six (15.78%) under regional anesthesia. A shunt was used in 19 patients. Right carotid endarterectomy was performed in 20 cases and left carotid endarterectomy in 18 cases. We used the primary closure technique in two of 38 cases and patches on 36 of them. We used Dacron in 21 cases, PTFE in 12 cases, and saphenous vein as a patch in three cases. In the WMS digit spam and recall scores, the postoperative period fell on the 2nd day, and then on the 4th and 30th day after the operation, there was a low level of increase over time. Compared with the preoperative period, the learning score was found to be the lowest on the 2nd day, lower on the 4th day compared with the preoperative period and improved compared with the preoperative period on the 30th day. There was no decrease in the verbal fluency test score results after the operation, on the contrary, it was observed minimally. The test score results cumulatively were decreased in the early postoperative periods compared with the preoperative period and increased on the 30th day compared with the preoperative period.

The purpose of CEA in the past was the prevention of ischemic stroke and cerebrovascular disease (CVD) rather than neurocognitive recovery. Factors affecting neurocognition in CEA are multifactorial. Preservation and improvement of neurocognition are more important than any other period of history. By prioritizing cognitive abilities in the treatment of carotid stenosis, individualization of the treatment will help maximize the increase in cognitive abilities by providing optimum benefit to the patient of each factor.