Cognitive Performance following Carotid Endarterectomy or Stenting in Asymptomatic Patients with Severe ICA Stenosis.
Background. Endarterectomy (CEA) or stenting (CAS) of a stenotic carotid artery is currently undertaken to reduce stroke risk. In addition removal of the arterial narrowing has been hypothesized to improve cerebral hemodynamics and provide benefits in cognitive functions, by supposedly resolving a "hypoperfusion" condition. Methods. In this study we sought to test whether resolution of a carotid stenosis is followed by measurable changes in cognitive functions in 22 subjects with "asymptomatic" stenosis. Results. A main finding of the study was the statistically significant pre-post difference observed in the performance of phonological verbal fluency and Rey's 15-word immediate recall. Remarkably, there was a significant interaction between phonological verbal fluency performance and side of the carotid intervention, as the improvement in the verbal performance, a typical "lateralized" skill, was associated with resolution of the left carotid stenosis. Conclusion. The results reflect a substantial equivalence of the overall performance at the before- and after- CEA or CAS tests. In two domains, however, the postintervention performance resulted improved. The findings support the hypothesis that recanalization of a stenotic carotid could improve brain functions by resolving hypothetical "hypoperfusion" states, associated with the narrowing of the vessels.
Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
Livio
L
Picchetto
Fondazione Santa Lucia, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS) and Memory Clinic, V. Ardeatina 306, 00179 Rome, Italy.
Gianfranco
G
Spalletta
Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
Barbara
B
Casolla
Fondazione Santa Lucia, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS) and Memory Clinic, V. Ardeatina 306, 00179 Rome, Italy.
Claudia
C
Cacciari
Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
Michele
M
Cavallari
Department of Vascular Surgery, Sant'Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035-1039, 00189 Rome, Italy.
Cristiano
C
Fantozzi
Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
Alessandro
A
Ciuffoli
Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
Maurizia
M
Rasura
Department of Neurology and Psychiatry (Parkinson's Centre) and Research Centre of Social Diseases (CIMS), University "La Sapienza", Viale dell'Università 20, 00185 Rome, Italy.
Francesca
F
Imperiale
Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
Giuliano
G
Sette
Fondazione Santa Lucia, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS) and Memory Clinic, V. Ardeatina 306, 00179 Rome, Italy.
Carlo
C
Caltagirone
Department of Vascular Surgery, Sant'Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035-1039, 00189 Rome, Italy.
Maurizio
M
Taurino
Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
Francesco
F
Orzi