Neuropsychological consequences of endarterectomy and endovascular angioplasty with stent placement for treatment of symptomatic carotid stenosis

Abstract

These results provide some reassurance that CAS is not associated with greater cognitive deterioration than CEA is.

The Role of Carotid Artery Stenting and Carotid Endarterectomy in Cognitive Performance

“…5, Twenty-five reported on cognitive outcome after CEA, 5,17-26,28 -42 4 after CAS, [43][44][45][46] and 3 after CEA versus CAS. 18,27,47 Overall, 16 used one or more control groups varying from healthy subjects to patients affected by different diseases. 18 Ten focused exclusively on symptomatic 5,17,21,28,33,35,43,45,27,47 and one on asymptomatic patients.…”

“…18,27,47 Overall, 16 used one or more control groups varying from healthy subjects to patients affected by different diseases. 18 Ten focused exclusively on symptomatic 5,17,21,28,33,35,43,45,27,47 and one on asymptomatic patients. 19 Time of cognitive assessment varied from 24 hours to 8 years after revascularization and 4 reported at 1 year or later (3 and 8 years).…”

“…No use of CPD was reported. All these studies were unable to find any significant difference in cognition between the 2 populations after revascularization, 18,27,47 although patients undergoing CAS performed worse on a single visuomotor test in the study by Crawley et al 27 Although microembolism was higher during CAS, no association between TCD-detected microembolism and cognitive impairment was reported. 27 Similarly, no significant changes in the S100␤ protein values were noted in patients undergoing CAS versus those undergoing CEA in the subgroup of the SPACE trial.…”

“…47 However, because only a small subgroup of the overall randomized population in both trials was analyzed for cognitive assessment, the sample to assess neurocognition could be unbalanced (Table 2). In the first 2 studies, 18,27 analyzing a subgroup of patients within CAVATAS, all procedures except one were performed by angioplasty alone, whereas in the SPACE subgroup, 47 a stent was systematically used. No use of CPD was reported.…”

Timing of carotid intervention

“…Of the 12 RCTs3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 that have compared carotid endarterectomy (CEA) with carotid artery stenting (CAS) in patients with significant carotid stenosis, only five3, 9, 10, 12, 14 provided information on the time from the index event to revascularization. CREST (Carotid Revascularization Endarterectomy versus Stenting Trial)10 reported the shortest median interval; this was still 22 days for CEA and 18 days for CAS.…”