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

Abstract

Carotid revascularization may lead to improved cognitive function beyond stroke prevention. This article summarizes the conclusions from available studies on the effects of carotid reperfusion procedures on cognitive function. The papers cited used different neuropsychological tests for cognitive assessment, resulting in different methodologies and the results obtained were not always convergent. However, most studies reported an improvement in neurocognitive abilities after both vascular interventions, but a more precise assessment of the specific benefits is still awaited. Clinical determinants to predict the effects of these treatments on cognitive function are still being sought, but results are not yet satisfactory. In view of these studies, carotid stenosis seems to be an independent risk factor for cognitive deterioration, and the main mechanisms responsible are embolism and cerebral hypoperfusion. The aim of this study is to order the knowledge about the effects of carotid artery stenting (CAS) and endarterectomy (CEA) on neurocognitive functions and to verify the usefulness of using these treatments.

Utility of sample entropy from intraoperative cerebral NIRS oximetry data in the diagnosis of postoperative cognitive improvement

“…Cognitive improvement after surgery is an important issue in perioperative medicine. Previous studies have reported cognitive benefits after CEA ( Shi et al, 2016 ; Robison et al, 2019 ; Relander et al, 2021 ; Piegza et al, 2021 ). In the present study, we found that patients with preoperative better cognitive function derived greater benefit from CEA than those who had lower preoperative MoCA scores.…”

“…Carotid endarterectomy (CEA) has proven effective for the treatment of high-grade cervical carotid stenosis ( Writers, 1998 ; Halliday et al, 2010 ). CEA has been associated with cognitive improvement after surgery, termed postoperative cognitive improvement (POCI) ( Shi et al, 2016 ; Robison et al, 2019 ; Relander et al, 2021 ; Piegza et al, 2021 ). It has been established that POCI after CEA is related to improvement in executive functions, which may benefit from improvement in cerebral hemodynamics and associated neuronal metabolism ( Relander et al, 2021 ).…”

Why do guidelines recommend screening for abdominal aortic aneurysms, but not for asymptomatic carotid stenosis? A plea for a randomized controlled trial

“…Given that fewer than 10,000 patients die annually in the United States from a rAAA (yet screening for AAAs is strongly recommended by both the SVS [13] and the ESVS [15] AAA guidelines), it seems unreasonable not to recommend selective screening for asymptomatic carotid atherosclerosis, when there is a several-fold higher number of strokes and stroke-related deaths due to AsxCS than deaths due to rAAAs [1,5]. Furthermore, there is evidence that AsxCS may have a detrimental effect on cognitive function, the main mechanisms being cerebral hypoperfusion and microembolism [61]. This cognitive dysfunction may often be reversed by a carotid revascularization procedure [62,63] Screening for asymptomatic carotid atherosclerosis should not be viewed as a means to identify candidates for CEA/CAS, but rather as an opportunity for the timely identification of high-risk individuals for ASCVD and cardiovascular events (MIs and strokes) and for the initiation of intensive medical therapy and risk factor modification.…”

Ischemia as a common trigger for Alzheimer’s disease

“…However, these have not yet been proven to affect cognitive function. Another intervention, namely carotid stenting, in asymptomatic individuals with ipsilateral ischemia and 80% stenosis, showed improved brain perfusion and cognitive function three months after the procedure ( Piegza et al, 2021 ). In addition, the beneficial cognitive effect of revascularization holds also for symptomatic patients with carotid stenosis ( Nishio et al, 2010 ; Chen et al, 2012 , 2017 ; Wendell et al, 2012 ; Piegza et al, 2021 ).…”