title: Association of the recovery of objective abnormal cerebral perfusion with neurocognitive improvement after carotid revascularization.
abstract: OBJECTIVE
  This study sought to report the effect of carotid artery stenting (CS) on neurocognitive function (NCF) in patients with severe carotid artery occlusive disease, depending on baseline brain perfusion status.
  
  
  BACKGROUND
  The effect of CS on NCF has been controversial.
  
  
  METHODS
  We prospectively enrolled 61 patients with carotid artery disease (22 with occlusion, 39 with severe stenosis) in whom CS was attempted. Computed tomography perfusion and NCF assessments including Mini-Mental State Examination (MMSE), Alzheimer Disease Assessment Scale-Cognitive subscale (ADAS-Cog), verbal fluency, and Color Trails Test Parts 1 and 2 were applied before and 3 months after intervention.
  
  
  RESULTS
  Successful recanalization was achieved in 14 of 22 occlusion patients (64%) and in all 39 severe stenosis patients. Two cases were excluded due to procedural cerebral complications. The patients were divided into 3 groups: group 1 (n = 8) consisted of patients with abnormal baseline ipsilateral cerebral perfusion in whom CS failed; group 2 (n = 33) consisted of patients with abnormal baseline ipsilateral cerebral perfusion in whom CS was successful; and group 3 (n = 19) consisted of patients without abnormal baseline ipsilateral cerebral perfusion in whom CS was successful. The demographics and baseline NCF were similar among groups. Only in group 2 was there significant improvement in ADAS-Cog (pre-procedure median [interquartile range]: 6 [4 to 9] vs. post-procedure: 5 [3 to 7], p = 0.002), MMSE (pre-procedure: 27 [25 to 28] vs. post-procedure: 28 [25 to 29], p = 0.004) and Color Trails Test Part 1 (pre-procedure: 100 [78.5 to 136.5] s vs. post-procedure: 97 [60 to 128.5] s, p = 0.003) after CS. Significant difference in changes from baseline was observed only in the Color Trails Test Part 1 among groups (group 1 vs. 2 vs. 3: 1.5 [-14 to 11.5] vs. -12.5 [-36.5 to 0.5] vs. -0.5 [-11 to 27], p = 0.0159). Significant correlation between the change of ipsilateral brain perfusion and MMSE (r = -0.33, p = 0.01) was also identified.
  
  
  CONCLUSIONS
  Successful CS for severe carotid stenosis/occlusion improves NCF, but only in patients with objective baseline abnormal cerebral perfusion.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ching-Chang
authors.initials: CC
authors.lastname: Huang
authors.forename: Ying-Hsien
authors.initials: YH
authors.lastname: Chen
authors.forename: Mao-Shin
authors.initials: MS
authors.lastname: Lin
authors.forename: Cheng-Hsin
authors.initials: CH
authors.lastname: Lin
authors.forename: Hung-Yuan
authors.initials: HY
authors.lastname: Li
authors.forename: Ming-Jang
authors.initials: MJ
authors.lastname: Chiu
authors.forename: Chi-Chao
authors.initials: CC
authors.lastname: Chao
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Wu
authors.forename: Ya-Fang
authors.initials: YF
authors.lastname: Chen
authors.forename: Jen-Kuang
authors.initials: JK
authors.lastname: Lee
authors.forename: Ming-Jiuh
authors.initials: MJ
authors.lastname: Wang
authors.forename: Ming-Fong
authors.initials: MF
authors.lastname: Chen
authors.forename: Hsien-Li
authors.initials: HL
authors.lastname: Kao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery; D002343:Carotid Artery, Internal / Q000473:pathology / Q000502:physiology / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D015607:Stents