Abstract WP474: Improvement of Cognitive Function and Reorganization of Brain Networks Following Carotid Endarterectomy and Carotid Artery Stenting

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Masaaki Kohta ◽  
Atsushi Fujita ◽  
Kohkichi Hosoda ◽  
Eiji Kohmura
Keyword(s):  
Cognitive Function ◽  
Functional Connectivity ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Cognitive Assessment ◽  
Carotid Artery Stenting ◽  
Special Focus ◽  
Neurocognitive Performance ◽  
Resting State Functional Connectivity ◽  
Revascularization Surgery

Background: Internal carotid artery stenosis (ICS) can lead to cognitive impairment as well as ischemic stroke. Although carotid revascularization surgery, such as carotid endarterectomy (CEA) and carotid artery stenting (CAS), can prevent future strokes, the effect of revascularization on cognitive function is controversial. In this study, we examined the resting-state functional connectivity (FC) in ICS patients undergoing revascularization surgery, with a special focus on the Default Mode Network (DMN). Methods: We prospectively enrolled 24 ICS patients, who were expecting the intervention of CEA (14 cases) or CAS (10 cases). Cognitive assessment, including the Mini-Mental State Examination (MMSE), the Frontal Assessement Battery (FAB), and the Japanese version of the Montreal Cognitive Assessment (MoCA-J) and rs-fMRI were administered ≤ 1 week preoperatively and postoperatively at 1 week. For the analysis of FC, a seed was placed in the region associated with DMN. Results: After revascularization surgery, significant improvement in the score of MMSE (27.4 vs 28.4, P = 0.03) and MoCA-J (23.1 vs 25.0, P = 0.0001) was found. As for the analysis of the CAS and CEA groups, the MoCA-J score of the CEA group (24.1 vs 26.1, P = 0.001) and the MMSE score of the CAS group (26.0 vs 28.4, P = 0.01) showed statistically significant improvements. In both CAS and CEA groups, Seed-to-Voxel focusing on DMN revealed increased connectivity between medial prefrontal cortex and precuneus. Conclusion: Both CEA and CAS are associated with an improvement in neurocognitive performance and reorganization of functional connectivity, including DMN.

scholarly journals Comparison of Cognitive Function after Carotid Artery Stenting versus Carotid Endarterectomy

2014 ◽  
Vol 47 (3) ◽  
pp. 221-231 ◽  
Author(s):  
K.I. Paraskevas ◽  
C. Lazaridis ◽  
C.M. Andrews ◽  
F.J. Veith ◽  
A.D. Giannoukas
Keyword(s):  
Cognitive Function ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting

scholarly journals Comparison of Cognitive Function After Carotid Artery Stenting Versus Carotid Endarterectomy

2014 ◽  
Vol 59 (3) ◽  
pp. 874
Author(s):  
K.I. Paraskevas ◽  
C. Lazaridis ◽  
C.M. Andrews ◽  
F.J. Veith ◽  
A.D. Giannoukas
Keyword(s):  
Cognitive Function ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting

scholarly journals Functional connectivity analysis and prediction of cognitive change after carotid artery stenting

2019 ◽  
Vol 131 (6) ◽  
pp. 1709-1715 ◽  
Author(s):  
Naoki Tani ◽  
Takahide Yaegaki ◽  
Akio Nishino ◽  
Kenta Fujimoto ◽  
Hiroyuki Hashimoto ◽  
...  
Keyword(s):  
Working Memory ◽  
Cognitive Function ◽  
Functional Connectivity ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Neuropsychological Tests ◽  
Cognitive Change ◽  
Cerebral Revascularization ◽  
Clinical Trial Registration ◽  
Adult Intelligence Scale

OBJECTIVEThe neurocognitive course of patients who have undergone cerebral revascularization has been the subject of many studies, and the reported effects of carotid artery stenting (CAS) on cognitive function have varied from study to study. The authors hypothesized that cognitive amelioration after CAS is associated with alteration of the default mode network (DMN) connectivity, and they investigated the correlation between functional connectivity (FC) of the DMN and post-CAS changes in cognitive function in order to find a clinical marker that can be used to predict the effect of cerebral revascularization on patients’ cognitive function in this preliminary exploratory study.METHODSThe authors examined post-CAS changes in cognitive function in relation to FC in patients treated for unilateral carotid artery stenosis. Resting-state functional MRI (rs-fMRI) was performed with a 3-T scanner before and 6 months after CAS in 8 patients. Neuropsychological tests (Wechsler Adult Intelligence Scale III and Wechsler Memory Scale–Revised) were administered to each patient before and 6 months after CAS. The DMN was mapped for each patient through independent component analysis of the rs-fMR images, and the correlation between FC of the DMN and post-CAS change in cognitive function was analyzed on a voxel level. Multivariable regression analysis was performed to identify preoperative factors associated with a post-CAS change in cognitive function.RESULTSPost-CAS cognitive function varied between patients and between categories of neuropsychological tests. Although there was no significant overall improvement in Working Memory scores after CAS, post-CAS Working Memory scores changed in negative correlation with changes in FC between the DMN and the precentral/superior frontal gyrus and between the DMN and the middle frontal gyrus. In addition, the preoperative FC between those areas correlated positively with the post-CAS improvement in working memory.CONCLUSIONSFC between the DMN and working memory–related areas is closely associated with improvement in working memory after CAS. Preoperative analysis of FC of the DMN may be useful for predicting postoperative improvement in the working memory of patients being treated for unilateral stenosis of the extracranial internal carotid artery.Clinical trial registration no.: UMIN000020045 (www.umin.ac.jp/ctr/index.htm)

Differential Effects of Carotid Artery Stenting Versus Carotid Endarterectomy on External Carotid Artery Patency

2007 ◽  
Vol 14 (2) ◽  
pp. 208-213 ◽  
Author(s):  
Edward Y. Woo ◽  
Jagajan Karmacharya ◽  
Omaida C. Velazquez ◽  
Jeffrey P. Carpenter ◽  
Christopher L. Skelly ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
External Carotid Artery ◽  
External Carotid ◽  
Differential Effects

scholarly journals Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study

BMJ ◽  
2021 ◽  
pp. n49
Author(s):  
Jeffrey J Perry ◽  
Marco L A Sivilotti ◽  
Marcel Émond ◽  
Ian G Stiell ◽  
Grant Stotts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Carotid Artery ◽  
Confidence Interval ◽  
Carotid Endarterectomy ◽  
Likelihood Ratio ◽  
Transient Ischaemic Attack ◽  
Carotid Artery Stenting ◽  
Stroke Risk ◽  
Ischaemic Attack

Abstract Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack. Design Prospective cohort study. Setting 13 Canadian emergency departments over five years. Participants 7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke. Main outcome measures The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit. Results Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had carotid endarterectomy/carotid artery stenting within seven days, and nine had both. The Canadian TIA Score stratified the risk of stroke, carotid endarterectomy/carotid artery stenting, or both within seven days as low (risk ≤0.5%; interval likelihood ratio 0.20, 95% confidence interval 0.09 to 0.44), medium (risk 2.3%; interval likelihood ratio 0.94, 0.85 to 1.04), and high (risk 5.9% interval likelihood ratio 2.56, 2.02 to 3.25) more accurately (area under the curve 0.70, 95% confidence interval 0.66 to 0.73) than did the ABCD2 (0.60, 0.55 to 0.64) or ABCD2i (0.64, 0.59 to 0.68). Results were similar for subsequent stroke regardless of carotid endarterectomy/carotid artery stenting within seven days. Conclusion The Canadian TIA Score stratifies patients’ seven day risk for stroke, with or without carotid endarterectomy/carotid artery stenting, and is now ready for clinical use. Incorporating this validated risk estimate into management plans should improve early decision making at the index emergency visit regarding benefits of hospital admission, timing of investigations, and prioritisation of specialist referral.

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