title: Neurocognitive functioning after carotid revascularization: a systematic review.
abstract: BACKGROUND
  The objective of this study was to review the recent literature regarding the neurocognitive consequences of carotid endarterectomy (CEA) and carotid stenting (CAS).
  
  
  RESULTS
  A PubMed and Web of Science search was conducted using the key words 'carotid' in combination with 'cognitive', 'cognition', 'neurocognition', 'neurocognitive', 'neuropsychology', and 'neuropsychological'. Bibliographies of relevant articles were cross-referenced. We included 37 studies published since 2007 of which 18 examined CEA, 12 CAS, and 7 compared CEA to CAS. There is a wide variability in the reported neurocognitive outcome following CEA and CAS. Nonetheless, none of the included studies unveiled significant differences between CEA and CAS on postoperative neurocognitive functioning. Postoperative changes observed for CEA and CAS separately seem limited to a small percentage (around 10-15%) of patients and can either present as an improvement or impairment.
  
  
  CONCLUSIONS
  The available data seem to suggest that no obvious cognitive differences between CAS and CEA can be observed after intervention. Both improvement and deterioration in cognitive functioning can be observed following CAS or CEA. Methodological differences such as patient heterogeneity, implementation and type of control groups, type of psychometric tests used, statistical analyses, or timing of the assessments play an important role in explaining the sometimes divergent results of the included studies. Large-scale and methodologically solid studies comparing CEA and CAS on neurocognitive outcome remain warranted. Future studies should implement adequate control groups to correct for practice effects in the target groups.
authors: Department of Experimental Psychology, Ghent University, Ghent, Belgium.
authors: Maarten
authors: M
authors: Plessers
authors: Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
authors: Isabelle
authors: I
authors: Van Herzeele
authors: Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
authors: Frank
authors: F
authors: Vermassen
authors: Department of Experimental Psychology, Ghent University, Ghent, Belgium.
authors: Guy
authors: G
authors: Vingerhoets
keywords: Carotid artery stenting; Carotid endarterectomy; Carotid revascularization; Cognitive outcome; Neuropsychology; Systematic review