Carotid endarterectomy improves cognitive function in patients with exhausted cerebrovascular reserve.
OBJECTIVE
To investigate changes in cognitive function following carotid endarterectomy (CEA).


METHODS
Prospective study with controls.


METHODS
CEA patients (n=159) were compared to a urology surgery control group (n=20). In CEA patients cerebrovascular reserve (CVR) was measured preoperatively. During surgery emboli and blood flow velocity in the middle cerebral artery were measured by transcranial Doppler (TCD) and cerebral oxygen saturation (CsO2) by near infrared spectroscopy. Cognitive function was measured preoperatively and at 5 days and 8 weeks postoperatively using a standardised computer battery of tests.


RESULTS
Only 8% of patients had normal CVR bilaterally. The median number of emboli during CEA was 12 (range 0-181). On carotid clamping, TCD velocity fell a median of 41% and cerebral oxygen saturation by 5%. Attention deteriorated compared to controls 5 days following CEA (p=0.003) and this deterioration was related to the rise in TCD velocity on declamping (r=-0.3, p=0.002). Median attention reaction times improved significantly by 8 weeks (p=0.001) especially in patients' with severely impaired CVR before surgery (p=0.02).


CONCLUSIONS
Attention improved at 2 months following CEA in patients with impaired CVR. CEA may offer more than reduced stroke risk to patients with impaired CVR.
Fearn
S J
SJ
University Hospital of South Manchester, Manchester, UK.
Hutchinson
S
S
Riding
G
G
Hill-Wilson
G
G
Wesnes
K
K
McCollum
C N
CN
D000368:Aged; D001288:Attention; D001783:Blood Flow Velocity; D016893:Carotid Stenosis / Q000503:physiopathology* / Q000523:psychology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D003071:Cognition; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D011930:Reaction Time; D017585:Ultrasonography, Doppler, Transcranial
D010100:Oxygen