title: Post-carotid endarterectomy neurocognitive decline is associated with cerebral blood flow asymmetry on post-operative magnetic resonance perfusion brain scans.
abstract: 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.
authors.affiliation: Department of Neurological Surgery, Columbia University, New York, NY 10032, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Wilson
authors.forename: J
authors.initials: J
authors.lastname: Mocco
authors.forename: Anthony L
authors.initials: AL
authors.lastname: D'Ambrosio
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Komotar
authors.forename: Joseph
authors.initials: J
authors.lastname: Zurica
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Kellner
authors.forename: David K
authors.initials: DK
authors.lastname: Hahn
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.forename: Celina
authors.initials: C
authors.lastname: Imielinska
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Heyer
mesh_terms: 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