Neuropsychological performance after carotid endarterectomy

Abstract

Background: Internal carotid endarterectomy (CEA) is a method of stroke prevention in patients with severe internal carotid artery (ICA) stenosis. Patients with significant carotid stenosis tend to have lower cognitive performance than those without significant stenosis. This is believed to be due to hypoperfusion or ongoing microembolization to the brain. Methods: We evaluated 60 patients with at least 70% ICA stenosis with the RBANS test (Repeatable Battery for the Assessment of Neuropsychological Status, Czech research version), preoperatively and one month a ter endarterectomy. Results: Neuropsychological follow-up was completed by N = 57 patients one month after the procedure. At the group level, there was a significant improvement in Language, Attention, Delayed Memory and Total Scale Index Scores (p < 0.05). Conclusions: CEA not only decreases the long-term risk of ischemic stroke, but may also improve cognitive performance. In a small percentage of cases, there is higher risk of embolic stroke and silent microembolization due to surgery, which may have a negative impact on cognitive function. However, we did not detect any cognitive impairment a ter CEA in our patients.

MRI Detection of Carotid Intraplaque Hemorrhage and Postintervention Cognition

“…One explanation for the less-thanexpected IPH(1) group's performance is microembolization during the intervention. 41 An association between vulnerable plaque and postintervention ischemic events has been previously shown. [42][43][44][45] During carotid endarterectomy, IPH increased the embolization risk, specifically during the dissection phase.…”

Another cause of treatable dementia: rapid cognitive improvement after carotid endarterectomy. Illustrative case

“… 7 reported that the MMSE results were often normal in patients with right-sided hemispheric stroke or mass lesions, whereas Kramska et al. 18 used the Repeatable Battery for the Assessment of Neuropsychological Status to minimize the potential learning effect responsible for higher postoperative scores when other tests are used. This shows the need for more unified and adaptable tests and the use of common standards, per the Hachinski et al.…”

“…Watanabe et al 16,17 noted the differences in the results obtained using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) and the superiority of the MoCA in detecting mild cognitive impairment. Moreover, Johnston et al 7 reported that the MMSE results were often normal in patients with right-sided hemispheric stroke or mass lesions, whereas Kramska et al 18 used the Repeatable Battery for the Assessment of Neuropsychological Status to minimize the potential learning effect responsible for higher postoperative scores when other tests are used. This shows the need for more unified and adaptable tests and the use of common standards, per the Hachinski et al recommendations.…”