Early Neuropsychological Outcome after Carotid Endarterectomy

Mononen, H.; Lepojärvi, Martti; Kallanranta, T.

doi:10.1159/000117366

Cited by 43 publications

(33 citation statements)

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“…1,2) This is due to showering of micro-emboli from the stenotic atherosclerosed carotid arteries. 4,7) CEA prevents the showering of these embolic episodes and also restores adequate circulation to the brain; hence, it should improve the neurocognitive functions. 8) However, this improvement in cognition related to CEA is still controversial.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] A controversy still exists whether carotid endarterectomy (CEA) does significantly improve the cognition and whether this improvement is statistically significant or not? Certain studies suggest that there is no clinically significant improvement 4) especially when permanent neurological damage has occurred. [4][5][6] However, other studies recommend CEA as it results in improved neurocognition.…”

Section: Introductionmentioning

confidence: 99%

“…Certain studies suggest that there is no clinically significant improvement 4) especially when permanent neurological damage has occurred. [4][5][6] However, other studies recommend CEA as it results in improved neurocognition. [5][6][7][8] This improvement in functions may be the result of reduction in the embolic showering 9,10) or due to improvement in the blood supply to the brain.…”

Section: Introductionmentioning

confidence: 99%

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Neurocognitive Improvement in Patients Undergoing Carotid Endarterectomy for Atherosclerotic Occlusive Carotid Artery Disease

Rashid

Jamil

Haq

et al. 2016

Annals of Vascular Diseases

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Objectives:To assess the improvement in neurocognitive functions after carotid endarterectomy (CEA) under local anesthesia (LA) in patients with carotid bifurcation occlusive disease. Place and duration of study: Department of Vascular Surgery, Combined Military Hospital Lahore from January 2013 to January 2015. Patients and Methods: A total of 79 patients with carotid artery occlusive disease, having no history of major stroke, depression, or dementia underwent CEA under LA. Cognitive functions were assessed 3 days before surgery and then 4 weeks and 12 weeks after the surgery using the Addenbrookes cognitive examination (ACE) score and General Practitioner Assessment of Cognition (GPCOG) Score. Results: In ACE score, Attention, Memory, Fluency, Language, and Visuospatial orientation improved by 33.3%, 30.7%, 21.4%, 38.4%, and 31.2%, respectively, by the end of 12 weeks. An overall improvement in neurocognition was 32% (P = 0.03). In GPCOG score, Orientation, Recall, and Memory improved by 33%, 20%, and 100%, respectively, with an overall improvement of 33.3% at the end of 12 weeks (P = 0.02). Conclusion: Both scoring systems show an overall improvement in neurocognition as well as improvements in all the subcategories in each system. Hence, we conclude statistically significant improvement in neurocognitive functions after CEA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neurocognitive Improvement in Patients Undergoing Carotid Endarterectomy for Atherosclerotic Occlusive Carotid Artery Disease

Rashid

Jamil

Haq

et al. 2016

Annals of Vascular Diseases

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“…Therefore, investigators study subtler forms of neurological injury, such as cognitive dysfunction, to improve the safety of this commonly performed procedure. 6,8,9,13,17,18,21 Cognitive dysfunction has important implications for quality of life 18,27 and has been shown to predict both earlier retirement and mortality. 25 Cognitive dysfunction is determined by evaluating cognitive performance with a battery of neuropsychometric tests before and after CEA to assess 4 functional domains-executive, verbal memory, visuospatial, and hand coordination.…”

mentioning

confidence: 99%

“…1,7,22 For example, postoperative language changes have been associated primarily with a left CEA. 2,3,15,16,21,24 To the best of our knowledge, no previous studies have associated the laterality of CEA with its influence on subtle postoperative hand deficits of coordination.…”

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confidence: 99%

Deficits of hand coordination and laterality of carotid endarterectomy

Heyer

Mallon²,

Mergeche³

et al. 2015

JNS

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OBJect Neurocognitive performance is used to assess multiple cognitive domains, including motor coordination, before and after carotid endarterectomy (CEA). Although gross motor strength is impaired with ischemia of large cortical areas or of the internal capsule, the authors hypothesize that patients undergoing CEA demonstrate significant motor deficits of hand coordination contralateral to the operative side, which is more clearly manifest in the nondominant hand than in the dominant hand with ischemia of smaller cortical areas. MetHODS The neurocognitive performance of 374 patients was evaluated with a battery of neuropsychometric tests. Both asymptomatic and symptomatic patients undergoing CEA were included. The authors evaluated the patients' dominant and nondominant hand performance on the Grooved Pegboard test, a test of hand coordination, to demonstrate their functional laterality. Neurocognitive dysfunction was evaluated as the difference in performance before and after CEA according to group-rate and event-rate analyses. The z scores were generated for all tests using a reference group of patients who were having simple spine surgery. Dominant and nondominant motor coordination functions were evaluated as raw scores and as calculated z scores. reSultS According to event-rate analysis, significantly more patients undergoing CEA of the opposite carotid artery demonstrated nondominant than dominant hand deficits of coordination (41.2% vs 26.4%, respectively, p = 0.02). Similarly, according to group-rate analysis, in patients undergoing CEA of the opposite carotid artery, raw difference scores from the Grooved Pegboard test reflected greater nondominant than dominant hand deficits of coordination (21.0 ± 54.4 vs 9.7 ± 37.0, respectively, p = 0.02). cOncluSiOnS Patients undergoing CEA of the opposite carotid artery are more likely to demonstrate nondominant than dominant hand deficits of coordination because of greater dexterity in the dominant hand before surgery.Clinical trial registration no.: NCT00597883 (ClinicalTrials.gov) http://thejns.org/doi/abs/10.3171/2014.8.JNS1459KeY WOrDS cerebrovascular disease/stroke; carotid endarterectomy; laterality; motor dysfunction; vascular disorders aBBreviatiOn CEA = carotid endarterectomy.

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Clinical relevance of intraoperative embolization detected by transcranial Doppler ultrasonography during carotid endarterectomy: A prospective study of 100 patients

Gaunt

Martin

Smith

et al. 1994

Journal of British Surgery

229

109

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A study was performed to investigate the clinical significance of microembolization detected by transcranial Doppler ultrasonography (TCD) by determining the quantity and character of emboli and correlating these with neurological and psychometric outcome, fundoscopy, automated visual field testing and computed tomographic brain scans in 100 consecutive patients undergoing carotid endarterectomy. Embolization was detected in 92 per cent of successfully monitored operations. Most emboli were characteristic of air and not associated with adverse clinical outcome. However, more than ten particulate emboli during initial carotid dissection correlated with a significant deterioration in postoperative cognitive function. A relationship between persistent particulate embolization in the immediate postoperative period, and both incipient carotid artery thrombosis and the development of major neurological deficits was observed. Immediate intervention, based on TCD evidence of embolization, has the potential to avert neurological deficits resulting from particulate embolization.

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Early Neuropsychological Outcome after Carotid Endarterectomy

Cited by 43 publications

References 0 publications

Neurocognitive Improvement in Patients Undergoing Carotid Endarterectomy for Atherosclerotic Occlusive Carotid Artery Disease

Neurocognitive Improvement in Patients Undergoing Carotid Endarterectomy for Atherosclerotic Occlusive Carotid Artery Disease

Deficits of hand coordination and laterality of carotid endarterectomy

Clinical relevance of intraoperative embolization detected by transcranial Doppler ultrasonography during carotid endarterectomy: A prospective study of 100 patients

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