Outcome from Carotid Endarterectomy. Neuropsychological Performances, Depressive Symptoms and Quality of Life: 8-Month Follow-up

Abstract

A preliminary study was carried out on a population of twenty-five consecutive and unselected patients undergoing carotid endarterectomy. A matched control group of subjects suffering from same pathology, but unoperated, was compared to experimental sample. A battery of neuropsychological tests, the Zung Self-Rating Depression Scale and the Jachuck's Quality of Life Impairment Scale were administered one week before surgery, two weeks after (surgical sample only) and then eight months later. The research shows that carotid endarterectomy does not impair neuropsychological performances, but produces some improvement, reaching significant level in the case of Word Fluency 1 and Similarities tests; depressive scores remained substantially unchanged, while quality of life improved slightly.

Impact of Carotid Endarterectomy upon Cognitive Functioning

“…These are displayed in table 1 [1, 4, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31]. …”

“…Seven studies [4, 17, 18, 20, 23, 26, 29]performed two post-operative assessments and one performed three [19]. The mean follow-up time of all 26 studies to the last assessment was 22 weeks.…”

“…Although many of the endarterectomy studies failed to measure mood state, those which did measure patient mood consistently reported an improvement postoperatively, both in anxiety [6, 16, 26]and depression [4, 16]. …”

“…An improvement in cognitive functioning may be expected from both reduced embolism and improved capacity to cope haemodynamically with hypotension or cardiac arrhythmia [4]. Alternatively, a deterioration in cognition may result from perioperative impairment in perfusion pressure or surgically triggered showers of emboli released into the brain [5].…”

Neuropsychological Changes in Patients with Carotid Stenosis after Carotid Endarterectomy

“…However, Bornstein et al [26], De Leo et al [27], and Greiffenstein et al [28] reported that verbal tasks improved in patients who underwent CEA on the right side, while no significant change was noted in patients who had CEA on the left side. Thus, a definite conclusion regarding the effect of CEA on cognitive function based on the operation side of CEA cannot be made based on these studies.…”