Cognitive performance after carotid angioplasty and stenting with brain protection devices.
OBJECTIVE
Neuropsychological outcomes after carotid endarterectomy (CEA) have been investigated extensively. However, cognitive impacts of carotid angioplasty and stenting (CAS), an emerging alternative to CEA, have not been studied. This study is aimed at investigating pattern and degree of cognitive changes after CAS among patients with high-grade carotid stenosis.


METHODS
Fifty-four patients with high-grade carotid artery stenosis and received elective CAS were followed. Sixty-six patients with similar medical conditions requiring carotid angiography (CAG) were enrolled as controls. Cognitive functions among patients in both groups were evaluated at baseline and follow-ups utilizing a battery of neuropsychometric tests. Results were analysed by inter-group and within-group comparisons.


RESULTS
There were no statistically significant differences between CAS and CAG patients regarding demographic characteristics, risk factors for stroke and baseline cognitive performance (p>0.05). CAS patients performed significantly better than CAG patients in Rey auditory verbal learning tests (RAVLT) at week 1 (41.2 +/- 5.2 versus 37.4 +/- 4.0, p<0.001) and week 12 follow-ups (43.3 +/- 7.7 versus 37.3 +/- 4.5, p<0.001). Comparison of z score also indicated CAS patients improved significantly more than CAG patients in RAVLT at both weeks 1 (1.08 +/- 1.29 versus 0.25 +/- 0.99, p<0.001) and 12 follow-ups (1.62 +/- 1.95 versus 0.05 +/- 1.02, p<0.001).


CONCLUSIONS
CAS patients demonstrated improvement in verbal memory after procedures. Correction of cerebral hypoperfusion and reduction of artery-to-artery embolization after CAS are postulated responsible for the cognitive improvement.
Xu
Gelin
G
Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China. gelinxu@gmail.com
Liu
Xinfeng
X
Meyer
John Stirling
JS
Yin
Qin
Q
Zhang
Renliang
R
D000368:Aged; D000704:Analysis of Variance; D017130:Angioplasty / Q000379:methods*; D016893:Carotid Stenosis / Q000601:surgery*; D016022:Case-Control Studies; D002544:Cerebral Infarction / Q000517:prevention & control*; D003071:Cognition / Q000502:physiology*; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications; D012189:Retrospective Studies