title: Comparison of domain-specific cognitive function after carotid endarterectomy and stenting.
abstract: BACKGROUND
  Observational data indicate that carotid artery stenting (CAS) is associated with higher incidence of subclinical cerebral microemboli than carotid endarterectomy (CEA). We hypothesized that CEA would be associated with superior performance on detailed domain-specific cognitive testing compared with CAS.
  
  
  METHODS
  Patients with >80% asymptomatic carotid artery stenosis were randomized to CEA or CAS with side of stenosis balanced across condition. A robust battery of tests was used to assess the cognitive domains of attention, memory, mood, visual-spatial skills, motor ability, processing speed, and executive functioning ≤10 days preoperatively and postoperatively at 6 weeks and 6 months. Tests were administered using standardized conditions and were scored by individuals blinded to treatment allocation.
  
  
  RESULTS
  Baseline cognitive performance was similar between CAS (n = 29) and CEA (n = 31) groups (P > .05). Relative to baseline, verbal and visual memory and attention functions substantially improved in the CAS and CEA groups at 6 months (multiple cognitive tests achieved statistical significance). Compared with CEA, cognitive processing speed (Stroop Color test: 9.0 vs 7.3, P = .04; and Stroop Word test: 9.0 vs 7.4, P = .05) was superior in the CAS group at 6 weeks. Executive functioning (phonemic verbal fluency: 10.6 vs 8.4, P = .043) and motor function (Grooved Pegboard of nondominant extremity: 45.7 vs 38.9, P = .022) were also superior in the CAS group at 6 months. Tests of attention, memory, and visual-spatial skills were similar between CAS and CEA patients at 6 weeks and 6 months.
  
  
  CONCLUSIONS
  Carotid revascularization improves memory and attention within the first 6 postoperative months. Compared with CEA, CAS produces improvements in cognitive processing speed, executive functioning, and motor function.
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex; Division of Vascular Surgery, Baylor College of Medicine, Houston, Tex. Electronic address: pkougias@bcm.edu.
authors.forename: Panos
authors.initials: P
authors.lastname: Kougias
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex; Department of Neurology, Baylor College of Medicine, Houston, Tex.
authors.forename: Robert
authors.initials: R
authors.lastname: Collins
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Tex.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pastorek
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex.
authors.forename: Sherene
authors.initials: S
authors.lastname: Sharath
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex; Division of Vascular Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: Neal R
authors.initials: NR
authors.lastname: Barshes
authors.affiliation: Department of Psychology, University of Houston, Houston, Tex.
authors.forename: Katie
authors.initials: K
authors.lastname: McCulloch
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex; Division of Vascular Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: George
authors.initials: G
authors.lastname: Pisimisis
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex; Department of Surgery, Baylor College of Medicine, Houston, Tex.
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
mesh_terms: D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D016893:Carotid Stenosis / Q000601:surgery*; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D006801:Humans; D009483:Neuropsychological Tests; D010865:Pilot Projects; D015607:Stents; D016896:Treatment Outcome