Neurocognitive changes after carotid revascularization: a review of the current literature.
OBJECTIVE
The objective of this study was to review the current literature evaluating the effect of carotid revascularization on neurocognitive function.


METHODS
A PubMed search was performed using the following keywords: carotid surgery, carotid stenosis, cognition, and cognition disorders. Bibliographies were cross referenced and related-articles searches were performed once an article of interest had been identified.


RESULTS
Twenty-two studies have been identified from the literature since 1998. Seventeen articles evaluated carotid endarterectomy (CEA), four evaluated carotid stenting, and one compared CEA to stenting. Eight studies found improvements in mood and/or cognition after revascularization, 11 studies showed mixed results, and 3 studies found declines.


CONCLUSIONS
There is no consensus within the current literature as to the effect of carotid revascularization on neurocognitive function. Further research--with attention to laterality of neurocognitive effects, patients' symptomatology at the time of presentation, the role of perioperative embolization, and trial design including adequate control groups and comparison between open surgery and stenting factors--is necessary in order to clarify the effects of carotid revascularization on cognition.
Department of Surgery, Yale University, New Haven, CT 06520, USA. loren.berman@yale.edu
Loren
L
Berman
Robert H
RH
Pietrzak
Linda
L
Mayes
D001921:Brain / Q000098:blood supply* / Q000601:surgery*; D002339:Carotid Arteries / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D009483:Neuropsychological Tests; D011182:Postoperative Care; D011300:Preoperative Care; D015607:Stents