title: Diffusion-weighted lesions after carotid artery stenting are associated with cognitive impairment.
abstract: The effect of carotid artery stenting (CAS) on cognitive function is still debated. Cerebral microembolism, detectable by post-procedural diffusion-weighted imaging (DWI) lesions, has been suggested to predispose to cognitive decline. Our study aimed at evaluating the effect of CAS on cognitive profile focusing on the potential role of cerebral microembolic lesions, taking into consideration the impact of factors potentially influencing cognitive status (demographic features, vascular risk profile, neuropsychological evaluation at baseline and magnetic resonance (MR) markers of brain structural damage). Thirty-seven patients with severe carotid artery stenosis were enrolled. Neurological assessment, neuropsychological evaluation and brain MR were performed the day before CAS (E0). Brain MR with DWI was repeated the day after CAS (E1), while neuropsychological evaluation was done after a 14-month median period (E2). Volumes of both white matter hyperintensities and whole brain were estimated at E0 on axial MR FLAIR and T1w-SE sequences, respectively. Unadjusted ANOVA analysis showed a significant CAS*DWI interaction for MMSE (F=7.154(32), p=.012). After adjusting for factors potentially influencing cognitive status CAS*DWI interaction was confirmed for MMSE (F=7.092(13), p=.020). Patients with DWI lesions showed a mean E2-E0 MMSE reduction of -3.1, while group without DWI lesions showed a mean E2-E0 MMSE of +1.1. Our study showed that peri-procedural brain microembolic load impacts negatively on cognitive functions, independently from the influence of patients-related variables.
authors.affiliation: Neurology Unit, Università Campus Bio-Medico di Roma, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Maggio
authors.forename: Claudia
authors.initials: C
authors.lastname: Altamura
authors.forename: Doriana
authors.initials: D
authors.lastname: Landi
authors.forename: Simone
authors.initials: S
authors.lastname: Migliore
authors.forename: Domenico
authors.initials: D
authors.lastname: Lupoi
authors.forename: Filomena
authors.initials: F
authors.lastname: Moffa
authors.forename: Livia
authors.initials: L
authors.lastname: Quintiliani
authors.forename: Stefano
authors.initials: S
authors.lastname: Vollaro
authors.forename: Paola
authors.initials: P
authors.lastname: Palazzo
authors.forename: Riccardo
authors.initials: R
authors.lastname: Altavilla
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pasqualetti
authors.forename: Yuri
authors.initials: Y
authors.lastname: Errante
authors.forename: Carlo Cosimo
authors.initials: CC
authors.lastname: Quattrocchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Tibuzzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Passarelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Arpesani
authors.forename: Guido
authors.initials: G
authors.lastname: di Giambattista
authors.forename: Francesco Rosario
authors.initials: FR
authors.lastname: Grasso
authors.forename: Giacomo
authors.initials: G
authors.lastname: Luppi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Vernieri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001288:Attention; D001921:Brain / Q000473:pathology*; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D017023:Coronary Angiography; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D018616:Ultrasonography, Doppler, Duplex