Long-term cognitive and neurovascular changes after carotid endarterectomy

Area of Science:

• Neuroscience
• Vascular Surgery
• Cognitive Psychology

Background:

• Carotid endarterectomy (CEA) outcomes on cognition are debated, with unclear neurovascular mechanisms.
• Previous studies show mixed results regarding cognitive decline or improvement post-CEA.

Purpose of the Study:

• To investigate the relationship between neurovascular indices and cognitive changes after CEA.
• To clarify the neurovascular mechanisms underlying cognitive alterations following CEA.

Main Methods:

• 55 patients with severe carotid stenosis underwent neuropsychological testing and neurovascular assessment (transcranial Doppler) pre- and post-CEA.
• Cognitive domains and hemisphere-specific functions were evaluated; comparisons made with 38 healthy controls.
• Linear mixed models and regression analyses assessed cognitive changes and associations with neurovascular indices.

Main Results:

• CEA patients showed significant working memory improvement compared to controls; no cognitive deterioration observed.
• Worse preoperative cerebrovascular reactivity, low pulsatility index, and poorer blood flow velocity correlated with cognitive improvements.
• Improvements were noted in executive functioning, ipsilateral cognitive functions, and complex attention.

Conclusions:

• CEA may confer long-term cognitive benefits, especially in patients with compromised preoperative circulatory adaptive mechanisms.
• Neurovascular indices are associated with cognitive changes, suggesting a role in post-CEA cognitive outcomes.