title: Improvement in executive function after unilateral carotid artery stenting for severe asymptomatic stenosis.
abstract: OBJECTIVE
  Executive functions are crucial for organizing and integrating cognitive processes. While some studies have assessed the effect of carotid artery stenting (CAS) on cognitive functioning, results have been conflicting. The object of this study was to assess the effect of CAS on cognitive status, with special interest on executive functions, among patients with severe asymptomatic internal carotid artery (ICA) stenosis.
  
  
  METHODS
  The authors prospectively assessed the neuropsychological status of 20 patients with unilateral asymptomatic extracranial ICA stenosis of 60% or more by using a comprehensive assessment battery focused on executive functions before and after CAS. Individual raw scores on neuropsychological tests were converted into z scores by normalizing for age, sex, and years of education. The authors compared baseline and 3-month postoperative neuropsychological scores by using Wilcoxon signed-rank tests.
  
  
  RESULTS
  The mean preoperative cognitive performance was within normal ranges on all variables. All patients underwent a successful CAS procedure. Executive function scores improved after CAS, relative to baseline performance as follows: set shifting (Trail-Making Test Part B: -0.75 ± 1.43 vs -1.2 ± 1.48, p = 0.003) and processing speed (digit symbol coding: -0.66 ± 0.85 vs -0.97 ± 0.82, p = 0.035; and symbol search: -0.24 ± 1.32 vs -0.56 ± 0.77, p = 0.049). The benefit of CAS for working memory was marginally significant (digit span backward: -0.41 ± 0.61 vs -0.58 ± 0.76, p = 0.052). Both verbal (immediate Rey Auditory Verbal Learning Test: 0.35 ± 1.04 vs -0.22 ± 0.82, p = 0.011) and visual (delayed Rey-Osterrieth Complex Figure: 0.27 ± 1.26 vs -0.22 ± 1.01, p = 0.024) memory improved after CAS.
  
  
  CONCLUSIONS
  The authors found a beneficial effect on executive function and memory 3 months after CAS among their prospective cohort of consecutive patients with unilateral and asymptomatic ICA stenosis of 60% or more.
authors.affiliation: Department of Interventional Cardiology, Favaloro University Hospital, Buenos Aires, Argentina.
authors.forename: Oscar A
authors.initials: OA
authors.lastname: Mendiz
authors.forename: Luciano A
authors.initials: LA
authors.lastname: Sposato
authors.forename: Nicolás
authors.initials: N
authors.lastname: Fabbro
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Lev
authors.forename: Analía
authors.initials: A
authors.lastname: Calle
authors.forename: León R
authors.initials: LR
authors.lastname: Valdivieso
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Fava
authors.forename: Francisco R
authors.initials: FR
authors.lastname: Klein
authors.forename: Teresa
authors.initials: T
authors.lastname: Torralva
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Gleichgerrcht
authors.forename: Facundo
authors.initials: F
authors.lastname: Manes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000523:psychology* / Q000628:therapy*; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D008570:Memory, Short-Term; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome