title: Effects of uncomplicated carotid endarterectomy on cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the internal carotid artery by comparison with unoperated patients.
abstract: OBJECTIVE
  The purpose of the present exploratory study was to evaluate the effects of uncomplicated carotid endarterectomy (CEA) on cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the internal carotid artery (ICA) by comparison with unoperated patients.
  
  
  METHODS
  Patients with age ≤75 years and unilateral asymptomatic severe stenosis (≥70%) of the cervical ICA underwent CEA with antiplatelet therapy (surgically treated group: 116 patients) or antiplatelet therapy alone or neither (medically treated group: 45 patients). For the surgically treated group, neuropsychological testing and brain perfusion measurement using single-photon emission computed tomography were performed within one month before surgery and one month after surgery. For the medically treated group, the same testing and measurement were performed twice at an interval of 1 to 2 months.
  
  
  RESULTS
  None of the operated patients developed new major ischemic events after surgery or intraoperative cerebral hyperperfusion. None of the patients in the medically treated group experienced neurological deficits including transient ischemic attacks during the study period. The incidence of patients with interval cognitive improvement was significantly greater in the surgically treated group (11 patients: 9%) than in the medically treated group (0%) (p = 0.0352). The incidence of patients with interval brain perfusion improvement in the ipsilateral cerebral hemisphere was significantly greater in the surgically treated group (24 patients: 21%) than in the medically treated group (0%) (p = 0.0003).
  
  
  CONCLUSIONS
  Uncomplicated CEA may improve cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the ICA when compared with unoperated patients.
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Daigo
authors.initials: D
authors.lastname: Kojima
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kubo
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Chida
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Sotaro
authors.initials: S
authors.lastname: Oshida
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Yoshida
authors.affiliation: a Department of Neurosurgery , Iwate Medical University , Morioka , Japan.
authors.forename: Shunro
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: b Cyclotron Research Center, School of Medicine , Iwate Medical University , Morioka , Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Terasaki
mesh_terms: D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000150:complications* / Q000601:surgery*; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010477:Perfusion; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
keywords: Asymptomatic carotid stenosis; Brain perfusion; Carotid endarterectomy; Cognition