title: Neurocognitive improvement after carotid artery stenting in patients with chronic internal carotid artery occlusion and cerebral ischemia.
abstract: OBJECTIVE
  Chronic cerebral hypoperfusion may lead to impairment in neurocognitive performance in patients with chronic internal carotid artery occlusion, and the effects of carotid artery stenting on neurocognitive function have been unclear.
  
  
  METHODS
  We prospectively enrolled 20 chronic internal carotid artery occlusion patients with objective ipsilateral hemisphere ischemia, in whom carotid artery stenting was attempted. Functional assessments, including the National Institutes of Health Stroke Scale, Barthel Index, and a battery of neuropsychological tests, including the Mini-Mental State Examination, Alzheimer Disease Assessment Scale-Cognitive Subtest, verbal fluency, and Color Trail Making A and B, were administered before and 3 months after intervention.
  
  
  RESULTS
  Successful recanalization was achieved in 12 of 20 patients (60%). There was no procedural or new cerebral ischemic event, except for 1 intracranial hemorrhage, which occurred during the procedure and had neurologic sequelae; this case was excluded from analysis. The demographics and baseline cognitive performance were similar between the group with a successful outcome (group 1, n=12) and patients who did not (group 2, n=7). Ten of 12 patients in group 1 had improvement in ipsilateral brain perfusion after the procedure, but none in group 2 had improvement. Significant improvement in the scores on the Alzheimer Disease Assessment Scale-Cognitive Subtest (before, 7.7±8.9 versus after, 5.7±7.1; P=0.024), Mini-Mental State Examination (before, 25.8±3.8 versus after, 27.7±2.7; P=0.015), and Color Trail Making A (before, 123.2±68.6 versus after, 99.3±51.5; P=0.017) were found in group 1 but not in group 2.
  
  
  CONCLUSIONS
  Successful carotid artery stenting improves global cognitive function as well as attention and psychomotor processing speed in patients with chronic internal carotid artery occlusion.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, and Graduate Institute of Clinical Medicine, Medical College, Department of Psychology, National Taiwan University, 7 Chung-Shan South Road, Taipei, Taiwan.
authors.forename: Mao-Shin
authors.initials: MS
authors.lastname: Lin
authors.forename: Ming-Jang
authors.initials: MJ
authors.lastname: Chiu
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Wu
authors.forename: Ching-Chang
authors.initials: CC
authors.lastname: Huang
authors.forename: Chi-Chao
authors.initials: CC
authors.lastname: Chao
authors.forename: Ying-Hsien
authors.initials: YH
authors.lastname: Chen
authors.forename: Hung-Ju
authors.initials: HJ
authors.lastname: Lin
authors.forename: Hung-Yuan
authors.initials: HY
authors.lastname: Li
authors.forename: Ya-Fang
authors.initials: YF
authors.lastname: Chen
authors.forename: Lung-Chun
authors.initials: LC
authors.lastname: Lin
authors.forename: Yen-Bin
authors.initials: YB
authors.lastname: Liu
authors.forename: Chia-Lun
authors.initials: CL
authors.lastname: Chao
authors.forename: Wen-Yih Isaac
authors.initials: WY
authors.lastname: Tseng
authors.forename: Ming-Fong
authors.initials: MF
authors.lastname: Chen
authors.forename: Hsien-Li
authors.initials: HL
authors.lastname: Kao
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D003072:Cognition Disorders / Q000209:etiology / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015607:Stents; D016896:Treatment Outcome