title: Cognition after carotid endarterectomy or stenting: a randomized comparison.
abstract: OBJECTIVE
  To compare the effect on cognition of carotid artery stenting (CAS) and carotid endarterectomy (CEA) for symptomatic carotid artery stenosis.
  
  
  METHODS
  Patients randomized to CAS or CEA in the International Carotid Stenting Study (ICSS; ISRCTN25337470) at 2 participating centers underwent detailed neuropsychological examinations (NPE) before and 6 months after revascularization. Ischemic brain lesions were assessed with diffusion-weighted imaging before and within 3 days after revascularization. Cognitive test results were standardized into z scores, from which a cognitive sumscore was calculated. The primary outcome was the change in cognitive sumscore between baseline and follow-up.
  
  
  RESULTS
  Of the 1,713 patients included in ICSS, 177 were enrolled in the 2 centers during the substudy period, of whom 140 had an NPE at baseline and 120 at follow-up. One patient with an unreliable baseline NPE was excluded. CAS was associated with a larger decrease in cognition than CEA, but the between-group difference was not statistically significant: -0.17 (95% CI -0.38 to 0.03; p = 0.092). Eighty-nine patients had a pretreatment MRI and 64 within 3 days after revascularization. New ischemic lesions were found twice as often after CAS than after CEA (relative risk 2.1; 95% CI 1.0 to 4.4; p = 0.041).
  
  
  CONCLUSIONS
  Differences between CAS and CEA in effect on cognition were not statistically significant, despite a substantially higher rate of new ischemic lesions after CAS than after CEA.
  
  
  METHODS
  This study provides Class III evidence that any difference between the effects of CAS and CEA on cognition at 6 months after revascularization is small.
authors: Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, PO Box 85500, G03.228, 3508 GA Utrecht, the Netherlands. a.altinbas@umcutrecht.nl
authors: A
authors: A
authors: Altinbas
authors: M J E
authors: MJ
authors: van Zandvoort
authors: E
authors: E
authors: van den Berg
authors: L M
authors: LM
authors: Jongen
authors: A
authors: A
authors: Algra
authors: F L
authors: FL
authors: Moll
authors: P J
authors: PJ
authors: Nederkoorn
authors: W P T M
authors: WP
authors: Mali
authors: L H
authors: LH
authors: Bonati
authors: M M
authors: MM
authors: Brown
authors: L J
authors: LJ
authors: Kappelle
authors: H B
authors: HB
authors: van der Worp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000523:psychology* / Q000601:surgery*; D003071:Cognition / Q000502:physiology*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects / Q000639:trends*; D016896:Treatment Outcome