title: Comparison of Neurocognitive Outcomes after Carotid Endarterectomy and Carotid Artery Stenting.
abstract: Cognitive and emotional outcomes after carotid endarterectomy (CEA) and carotid artery stenting with embolic protection device (CAS + EPD) are not clear. Patients were entered prospectively into a United States Food and Drug Administration-approved single-center physician-sponsored investigational device exemption between 2004 and 2010 and received either CEA or CAS + EPD. Patients underwent cognitive testing preprocedure and at 6, 12, and 60 months postprocedure. Cognitive domains assessed included attention, memory, executive, motor function, visual spatial functioning, language, and processing speed. Beck Depression and anxiety scales were also compared. There were a total of 38 patients that met conventional indications for carotid surgery (symptomatic with ≥50% stenosis or asymptomatic with ≥70% stenosis)-12 patients underwent CEA, whereas 26 patients underwent CAS + EPD. Both CEA and CAS + EPD patients showed postprocedure improvement in memory and executive function. No differences were seen at follow-up in regards to emotional dysfunction (depression and anxiety), attention, visual spatial functioning, language, motor function, and processing speed. Only two patients underwent neuropsychiatric testing at 60 months-these CAS + EPD patients showed sustained improvement in memory, visual spatial, and executive functions. In conclusion, cognitive and emotional outcomes were similar between CEA and CAS + EPD patients.
authors.affiliation: Department of Surgery at Harbor-University of California Medical Center and Los Angeles Biomedical Research Institute at Harbor-University of California, USA.
authors.forename: Jerry J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Samuel
authors.initials: S
authors.lastname: Schwartz
authors.forename: Johnny
authors.initials: J
authors.lastname: Wen
authors.forename: Christian
authors.initials: C
authors.lastname: deVirgilio
authors.forename: Abeline
authors.initials: A
authors.lastname: Lobue
authors.forename: Irwin
authors.initials: I
authors.lastname: Walot
authors.forename: Matthew
authors.initials: M
authors.lastname: Koopmann
authors.forename: Carlos
authors.initials: C
authors.lastname: Donayre
authors.forename: Rodney A
authors.initials: RA
authors.lastname: White
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D017536:Carotid Artery, Common / Q000601:surgery*; D016893:Carotid Stenosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D003071:Cognition; D004644:Emotions; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome