title: Intervention versus Aggressive Medical Therapy for Cognition in Severe Asymptomatic Carotid Stenosis.
abstract: OBJECTIVE
  Asymptomatic carotid stenosis of ≥70% increases the incidence of microembolism and/or chronic hypoperfusion, which may consequently impair neurocognition and brain connections. We sought controlled evidence for any cognitive benefit of aggressive medical therapy and combined carotid revascularization.
  
  
  METHODS
  Patients with asymptomatic, unilateral, ≧70% stenosis of the extracranial ICA chose either aggressive medical therapy alone or in combination with carotid artery stent placement in this nonrandomized controlled study. They were examined with a battery of neuropsychological tests, structural MR imaging, DTI, and resting-state fMRI before and 3 months after treatment.
  
  
  RESULTS
  Forty patients were included with 15 in the medical group and 25 in the stent-placement group. Among them, 13 and 21 in the respective groups completed neuroimaging follow-up. The baseline characteristics and the changes in cognitive performance during 3 months showed no differences between treatment groups. Nevertheless, compared with the medical group, the stent-placement group showed subjective dizziness alleviation (P= .045) and a small increase in fractional anisotropy at the splenium of the corpus callosum and the posterior periventricular white matter ipsilateral to carotid artery stent placement. Moreover, only the stent-placement group showed interval improvement in immediate memory and visuospatial performance, which was accompanied by an increase of functional connectivity at the insular cortex of the dorsal attention network and the medial prefrontal cortex of the default mode network.
  
  
  CONCLUSIONS
  Both aggressive medical therapy alone and combined carotid revascularization in ≧70% asymptomatic carotid stenosis similarly preserved cognition during 3-month follow-up, though the latter had the potential for dizziness alleviation and cognitive and connectivity enhancement.
authors.affiliation: From the Departments of Neurology (C.-J.L., P.-N.W., I.-H.L.).|Institute of Brain Science (C.-J.L., P.-C.T., I.-H.L.).
authors.forename: C-J
authors.identifier: http://orcid.org/0000-0002-5965-096X
authors.initials: CJ
authors.lastname: Lin
authors.affiliation: Radiology (F.-C.C.).
authors.forename: F-C
authors.identifier: http://orcid.org/0000-0002-9244-3399
authors.initials: FC
authors.lastname: Chang
authors.affiliation: Institute of Neuroscience (K.-H.C., C.-P.L.).
authors.forename: K-H
authors.identifier: http://orcid.org/0000-0002-6776-4094
authors.initials: KH
authors.lastname: Chou
authors.affiliation: Medical Education and Research (P.-C.T.), Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Brain Science (C.-J.L., P.-C.T., I.-H.L.).
authors.forename: P-C
authors.identifier: http://orcid.org/0000-0002-9403-4660
authors.initials: PC
authors.lastname: Tu
authors.affiliation: Department and Institute of Physiology (Y.-H.L.).
authors.forename: Y-H
authors.identifier: http://orcid.org/0000-0002-3213-827X
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Institute of Neuroscience (K.-H.C., C.-P.L.).
authors.forename: C-P
authors.identifier: http://orcid.org/0000-0001-6848-8776
authors.initials: CP
authors.lastname: Lin
authors.affiliation: From the Departments of Neurology (C.-J.L., P.-N.W., I.-H.L.).|School of Medicine (P.-N.W.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: P-N
authors.identifier: http://orcid.org/0000-0001-9902-1386
authors.initials: PN
authors.lastname: Wang
authors.affiliation: From the Departments of Neurology (C.-J.L., P.-N.W., I.-H.L.) ihlee@vghtpe.gov.tw.|Institute of Brain Science (C.-J.L., P.-C.T., I.-H.L.).
authors.forename: I-H
authors.identifier: http://orcid.org/0000-0002-5344-6685
authors.initials: IH
authors.lastname: Lee