A Prospective Evaluation of Systemic Biomarkers and Cognitive Function Associated with Carotid Revascularization

Abstract

Objective To determine factors affecting cognition and identify predictors of long-term cognitive impairment following carotid revascularization procedures. Background Cognitive impairment is common in older patients with carotid occlusive diseases. Methods Patients undergoing carotid intervention for severe occlusive diseases were prospectively recruited. Patients received neurocognitive testing before, 1, and 6 months after carotid interventions. Plasma samples were also collected within 24 hours after carotid intervention and inflammatory cytokines were analyzed. Univariate and multivariate logistic regressions were performed to identify risk factors associated with significant cognitive deterioration (>10% decline). Results A total of 98 patients (48% symptomatic) were recruited, including 55 patients receiving carotid stenting and 43 receiving endarterectomy. Mean age was 69 (range 54–91 years). Patients had overall improvement in cognitive measures 1 month after revascularization. When compared with carotid stenting, endarterectomy patients demonstrated postoperative improvement in cognition at 1 and 6 months compared with baseline. Carotid stenting (odds ratio 6.49, P = 0.020) and age greater than 80 years (odds ratio 12.6, P = 0.023) were associated with a significant long-term cognitive impairment. Multiple inflammatory cytokines also showed significant changes after revascularization. On multivariate analysis, after controlling for procedure and age, IL-12p40 (P = 0.041) was associated with a higher risk of significant cognitive impairment at 1 month; SDF1-α (P = 0.004) and tumor necrosis factor alpha (P = 0.006) were independent predictors of cognitive impairment, whereas interleukin-6 (P = 0.019) demonstrated cognitive protective effects at 6 months after revascularization. Conclusions Carotid interventions affect cognitive function. Systemic biomarkers can be used to identify patients at risk of significant cognitive decline postprocedures that benefit from targeted cognitive training.

Connectometry evaluation in patients undergoing carotid endarterectomy: an exploratory study

“…The correlation between carotid artery stenosis, cognitive function and brain connectivity impairments was described in previous researches. For example, it is known that both CAS and CEA are associated with long-term improvements in cognitive performances [45].…”

“…Another limit is the use of MMSE as the only test used for the evaluation of the cognitive functions of the patients: cognitive improvements seen after CEA were already demonstrated in previous researches that patients who underwent CEA showed improvements in cognition, mood and quality of life tests [8,45]. Even if MMSE is not the most appropriate test for cognitive analysis in patients with ICA stenosis, it was used as surrogate test in order to give general indications on the trend of neurocognitive performances before and after the surgical procedure due the exploratory intent of the study.…”

Cognitive Functions in Patients after Carotid Artery Revascularization—A Narrative Review

“…Interestingly, executive functions measured with the MoCA improved significantly only in patients after CEA, whereas memory measured with the MoCA improved in both the post-CEA and pharmacologically treated groups. In general, both intervention methods improved the MoCA score, but CAS did not cause improvement in any subscale [49].…”

Carotid artery stenosis and inflammatory biomarkers: the role of inflammation-induced immunological responses affecting the vascular systems

“…Zuniga and colleagues also showed that inflammatory biomarkers such as IL-12p40, SDF1-α and TNF correlated with the occurrence of cognitive dysfunction after CEA or CAS (41). When compared with carotid stenting (55 patients), endarterectomy (43 patients) demonstrated postoperative improvement in cognition at one and six months compared with the baseline.…”