Post-carotid endarterectomy neurocognitive decline is associated with cerebral blood flow asymmetry on post-operative magnetic resonance perfusion brain scans.
OBJECTIVE
Up to 25% of patients experience subtle declines in post-operative neurocognitive function following, otherwise uncomplicated, carotid endarterectomy (CEA). We sought to determine if post-CEA neurocognitive deficits are associated with cerebral blood flow (CBF) abnormalities on post-operative MR perfusion brain scans.


METHODS
We enrolled 22 CEA patients to undergo a battery of neuropsychometric tests pre-operatively and on post-operative day 1 (POD 1). Neurocognitive dysfunction was defined as a two standard deviation decline in performance in comparison to a similarly aged control group of lumbar laminectomy patients. All patients received MR perfusion brain scans on POD 1 that were analysed for asymmetries in CBF distribution. One patient experienced a transient ischemic attack within 24 hours before the procedure and was excluded from our analysis.


RESULTS
Twenty-nine percent of CEA patients demonstrated neurocognitive dysfunction on POD 1. One hundred percent of those patients with cognitive deficits demonstrated CBF asymmetry, in contrast to only 27% of those patients without cognitive impairment. Post-CEA cognitive dysfunction was significantly associated with CBF abnormalities (RR=3.75, 95% CI: 1.62-8.67, p=0.004).


CONCLUSIONS
Post-CEA neurocognitive dysfunction is significantly associated with post-operative CBF asymmetry. These results support the hypothesis that post-CEA cognitive impairment is caused by cerebral hemodynamic changes. Further work exploring the relationship between CBF and post-CEA cognitive dysfunction is needed.
Wilson
David A
DA
Department of Neurological Surgery, Columbia University, New York, NY 10032, USA.
Mocco
J
J
D'Ambrosio
Anthony L
AL
Komotar
Ricardo J
RJ
Zurica
Joseph
J
Kellner
Christopher P
CP
Hahn
David K
DK
Connolly
E Sander
ES
Liu
X
X
Imielinska
Celina
C
Heyer
Eric J
EJ
D000368:Aged; D000369:Aged, 80 and over; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003072:Cognition Disorders / Q000209:etiology* / Q000378:metabolism; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000503:physiopathology*; D012307:Risk Factors