Elevations in preoperative monocyte count predispose to acute neurocognitive decline after carotid endarterectomy for asymptomatic carotid artery stenosis.
OBJECTIVE
Although the incidence of major stroke attributable to carotid endarterectomy (CEA) is low (1% to 2%), approximately 25% of patients experience subtle postoperative neurocognitive dysfunction. This study examines whether preoperative leukocyte profiles predict cognitive outcome in asymptomatic CEA patients.


METHODS
Sixty-nine asymptomatic CEA patients underwent neuropsychometric testing preoperatively and on postoperative day 1 (POD1). Preoperative white blood cell counts and differentials were obtained. Logistic regression was performed for risk factors for neurocognitive decline. Variables achieving univariate P<0.10 were included in multivariate analysis.


RESULTS
Eighteen (26%) patients experienced neurocognitive decline on POD1; multivariate analysis demonstrated that preoperative monocyte count (P=0.011) and age (P=0.02) independently predicted outcome.


CONCLUSIONS
Preoperative monocyte count and age are independently associated with acute neurocognitive decline after CEA for asymptomatic stenosis.
Mocco
J
J
Department of Neurosurgery, Columbia University, New York, NY 10032, USA. jdm32@columbia.edu
Wilson
David A
DA
Ducruet
Andrew F
AF
Komotar
Ricardo J
RJ
Mack
William J
WJ
Zurica
Joseph
J
Sciacca
Robert R
RR
Heyer
Eric J
EJ
Connolly
E Sander
ES
D000367:Age Factors; D000368:Aged; D002343:Carotid Artery, Internal / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000473:pathology; D003071:Cognition; D015331:Cohort Studies; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000473:pathology; D007962:Leukocytes / Q000166:cytology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000166:cytology*; D015999:Multivariate Analysis; D019636:Neurodegenerative Diseases / Q000473:pathology*; D012044:Regression Analysis; D012307:Risk Factors