Neuropsychological consequences of endarterectomy and endovascular angioplasty with stent placement for treatment of symptomatic carotid stenosis: a prospective randomised study.
OBJECTIVE
Previous studies compared carotid endarterectomy (CEA) and carotid artery stent placement (CAS) for treatment of symptomatic carotid artery stenosis. Whereas most previous studies showed both treatment modalities to be associated with a comparable risk of periprocedural cerebrovascular complications, these previous studies have shown significantly more microemboli and significantly more lesions in diffusion-weighted MR imaging after CAS compared to CEA. The clinical relevance of these differences remains unknown. We therefore compared the neuropsychological consequences of CAS and CEA and additionally measured the S100beta protein, a marker of cerebral damage.


METHODS
A total of 48 patients with symptomatic carotid artery stenosis greater than 70 % (according to ECST criteria) were enrolled and 45 patients participated in the follow-up. The patients were randomly assigned for CEA (24 patients) or CAS (21 patients). S100beta protein values were evaluated 2 hours before the procedure, as well as one and two hours thereafter. Patients were assessed before treatment, and again 6 and 30 days after treatment using a comprehensive neuropsychological test battery.


RESULTS
Patients of the CAS and the CEA groups did not significantly differ in terms of age, gender, education, degree of carotid artery stenosis, cerebrovascular symptoms and vascular risk factors. Following previously used criteria, a cognitive change in patients was assumed to have occurred when there was a decline of more than one standard deviation in two or more tests assessing various cognitive domains. Six days and 30 days after the treatment both groups showed a comparable number of patients with cognitive changes compared to baseline. There were no significant differences in S100beta protein values.


CONCLUSIONS
These results provide some reassurance that CAS is not associated with greater cognitive deterioration than CEA is.
Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 10, 24105 Kiel, Germany. k.witt@neurologie.uni-kiel.de
Karsten
K
Witt
Katharina
K
Börsch
Christine
C
Daniels
Knut
K
Walluscheck
Karsten
K
Alfke
Olav
O
Jansen
Norbert
N
Czech
Günther
G
Deuschl
Robert
R
Stingele
D000368:Aged; D000704:Analysis of Variance; D000800:Angioplasty, Balloon / Q000379:methods*; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000473:pathology / Q000523:psychology / Q000628:therapy; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000378:metabolism; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000378:metabolism; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors
D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins