title: Elevations in preoperative monocyte count predispose to acute neurocognitive decline after carotid endarterectomy for asymptomatic carotid artery stenosis.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Columbia University, New York, NY 10032, USA. jdm32@columbia.edu
authors.forename: J
authors.initials: J
authors.lastname: Mocco
authors.forename: David A
authors.initials: DA
authors.lastname: Wilson
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Ducruet
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Komotar
authors.forename: William J
authors.initials: WJ
authors.lastname: Mack
authors.forename: Joseph
authors.initials: J
authors.lastname: Zurica
authors.forename: Robert R
authors.initials: RR
authors.lastname: Sciacca
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Heyer
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: 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