The Impact of Carotid Artery Stenting on Cognitive Function in Patients with Extracranial Carotid Artery Stenosis

Antonopoulos, Constantine N.; Kakisis, John D.; Sfyroeras, George S.; Moulakakis, Konstantinos G.; Kallinis, Aristides; Giannakopoulos, Triantafillos G.; Liapis, Christos D.

doi:10.1016/j.avsg.2014.10.024

Cited by 25 publications

(22 citation statements)

References 44 publications

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“…Accordingly, different investigations have suggested that cognitive deficits may specifically affect a subgroup of subjects in which the carotid lumen narrowing is associated to an impaired cerebral hemodynamic status. 1,2,9 This consideration may also explain the lack of strongly encouraging results obtained by the surgical correction of carotid stenosis or occlusion in terms of improvement of cognitive performance 31,32 and further underlines the need to find a marker of a preclinical status preceding loss of cognition. [33][34][35] By considering the complexity of the brain network subtending cognitive functions, its vascular-metabolic balance is probably more fragile and susceptible to reach a critical threshold for ischemic damage at an earlier stage with respect to that involved in the control of other functions.…”

Section: Discussionmentioning

confidence: 99%

Thresholds of impaired cerebral hemodynamics that predict short-term cognitive decline in asymptomatic carotid stenosis

Buratti

Viticchi

Falsetti³

et al. 2016

J Cereb Blood Flow Metab

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Subjects with asymptomatic carotid stenosis (ACS) may be at risk of cognitive impairment due to cerebral hypoperfusion. In this study, we aimed to detect a threshold of cerebral hemodynamics which is able to identify subjects at risk of cognitive deterioration. In subjects with ACS, cerebral vasomotor reactivity (CVR) was assessed with the breath-holding index (BHI) transcranial Doppler-based method. Cognitive deterioration was defined as a decrease in the MMSE score by !2 points after one year. In order to define the threshold of impaired BHI, a ROC curve analysis was performed adopting the binary difference of MMSE score as the outcome and continuous BHI as the testing variable. A total of 548 subjects completed the follow-up. Cognitive deterioration was observed in 119 patients (21.7%). The BHI value ipsilateral to the stenosis was the strongest predictor of cognitive deterioration among the variables tested. The best cut-point to discriminate between normal and abnormal BHI resulted 0.89. The post-test probability of cognitive deterioration for an abnormal BHI was 44%, while a normal BHI showed a post-test probability of 9% for the same outcome. The present investigation provides a threshold of reduced CVR that can be useful to identify subjects with ACS at risk of cognitive deterioration.

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Section: Discussionmentioning

confidence: 99%

Thresholds of impaired cerebral hemodynamics that predict short-term cognitive decline in asymptomatic carotid stenosis

Buratti

Viticchi

Falsetti³

et al. 2016

J Cereb Blood Flow Metab

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“…A number of potential interventions for small cerebral vessel pathology have been identified, including neurotrophins, endothelin antagonists, NO donors, prostacyclin mimetics, phosphodiesterase inhibitors, and peroxisome proliferator-activated receptor-g agonists. 55 However, at present there are no specific therapies approved to improve cerebrovascular perfusion beyond carotid angioplasty, 56 control of systemic arterial blood pressure 57 and blood glucose, 58 and reduction of hypercholesterolemia. 59 AD is characterized by a cerebral cholinergic deficit.…”

Section: Cerebrovascular Function and Admentioning

confidence: 99%

Intermittent hypoxia training protects cerebrovascular function in Alzheimer's disease

Манухина

Downey

Shi

et al. 2016

Exp Biol Med (Maywood)

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Alzheimer's disease (AD) is a leading cause of death and disability among older adults. Modifiable vascular risk factors for AD (VRF) include obesity, hypertension, type 2 diabetes mellitus, sleep apnea, and metabolic syndrome. Here, interactions between cerebrovascular function and development of AD are reviewed, as are interventions to improve cerebral blood flow and reduce VRF. Atherosclerosis and small vessel cerebral disease impair metabolic regulation of cerebral blood flow and, along with microvascular rarefaction and altered trans-capillary exchange, create conditions favoring AD development. Although currently there are no definitive therapies for treatment or prevention of AD, reduction of VRFs lowers the risk for cognitive decline. There is increasing evidence that brief repeated exposures to moderate hypoxia, i.e. intermittent hypoxic training (IHT), improve cerebral vascular function and reduce VRFs including systemic hypertension, cardiac arrhythmias, and mental stress. In experimental AD, IHT nearly prevented endothelial dysfunction of both cerebral and extra-cerebral blood vessels, rarefaction of the brain vascular network, and the loss of neurons in the brain cortex. Associated with these vasoprotective effects, IHT improved memory and lessened AD pathology. IHT increases endothelial production of nitric oxide (NO), thereby increasing regional cerebral blood flow and augmenting the vaso-and neuroprotective effects of endothelial NO. On the other hand, in AD excessive production of NO in microglia, astrocytes, and cortical neurons generates neurotoxic peroxynitrite. IHT enhances storage of excessive NO in the form of S-nitrosothiols and dinitrosyl iron complexes. Oxidative stress plays a pivotal role in the pathogenesis of AD, and IHT reduces oxidative stress in a number of experimental pathologies. Beneficial effects of IHT in experimental neuropathologies other than AD, including dyscirculatory encephalopathy, ischemic stroke injury, audiogenic epilepsy, spinal cord injury, and alcohol withdrawal stress have also been reported. Further research on the potential benefits of IHT in AD and other brain pathologies is warranted.

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“…14,15 Single-arm studies of carotid revascularization accomplished by either carotid endarterectomy or CAS reported the controversial results of cognitive enhancement in patients with asymptomatic carotid stenosis. [15][16][17][18][19][20] However, there is a lack of medical-controlled evidence reflecting contemporary medical improvement and risk-benefit balance of interventions for cognitive preservation. Here, we investigate the impact of aggressive medical treatment with or without combined carotid revascularization on neurocognitive and connectivity outcomes at 3 months after treatment in patients with м70% asymptomatic carotid stenosis.…”

mentioning

confidence: 99%

Intervention versus Aggressive Medical Therapy for Cognition in Severe Asymptomatic Carotid Stenosis

Lin

Chang²,

Chou

et al. 2016

AJNR Am J Neuroradiol

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The Impact of Carotid Artery Stenting on Cognitive Function in Patients with Extracranial Carotid Artery Stenosis

Cited by 25 publications

References 44 publications

Thresholds of impaired cerebral hemodynamics that predict short-term cognitive decline in asymptomatic carotid stenosis

Thresholds of impaired cerebral hemodynamics that predict short-term cognitive decline in asymptomatic carotid stenosis

Intermittent hypoxia training protects cerebrovascular function in Alzheimer's disease

Intervention versus Aggressive Medical Therapy for Cognition in Severe Asymptomatic Carotid Stenosis

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