title: Comparison of cognitive function after carotid artery stenting versus carotid endarterectomy.
abstract: The effect of carotid artery stenting (CAS) and carotid endarterectomy (CEA) on cognitive function is unclear. Both cognitive improvement and decline have been reported after CAS and CEA. We aimed to compare the changes in postprocedural cognitive function after CAS versus CEA. A systematic qualitative review of the literature was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement for studies evaluating the changes in cognitive function after CAS compared with CEA. Thirteen studies (403 CEAs; 368 CAS procedures) comparing the changes in cognitive function after CEA versus CAS were identified. Most studies did not show significant differences in overall cognitive function or only showed a difference in a single cognitive test between the two procedures. A definitive conclusion regarding the effect of CAS versus CEA on cognitive function was not possible owing to heterogeneity in definition, method, timing of assessment, and type of cognitive tests. For the same reasons, performing a meta-analysis was not feasible. The lack of standardization of specific cognitive tests and timing of assessment of cognitive function after CAS and CEA do not allow for definite conclusions to be drawn. Larger, adequately-powered and appropriately designed studies are required to accurately evaluate the effect of CAS versus CEA on postprocedural cognitive function.
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, Larissa, Greece. Electronic address: paraskevask@hotmail.com.
authors.forename: K I
authors.initials: KI
authors.lastname: Paraskevas
authors.affiliation: Department of Neurology, Division of Neurocritical Care and Vascular Neurology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: C
authors.initials: C
authors.lastname: Lazaridis
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Andrews
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA; Division of Vascular Surgery, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: F J
authors.initials: FJ
authors.lastname: Veith
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, Larissa, Greece.
authors.forename: A D
authors.initials: AD
authors.lastname: Giannoukas
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects; D058070:Asymptomatic Diseases / Q000453:epidemiology; D016893:Carotid Stenosis / Q000601:surgery / Q000628:therapy*; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology*; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D012196:Review Literature as Topic; D015607:Stents
keywords: Carotid artery stenting; Carotid endarterectomy; Cognitive function