Cognitive function and carotid stenosis: review of the literature

ABSTRACT Stroke is a known cause of cognitive impairment but the relationship between asymptomatic carotid artery stenosis and cognitive function is not clear. The main risk factors for vascular disease are also related to carotid stenosis and cognitive impairment. The association of high-grade stenosis of the internal carotid artery with cognitive impairment is related to silent embolization and hypoperfusion, but it may also be present without evidence of infarction on magnetic resonance imaging. Carotid stenosis treatment may lead to a decline in cognitive function due to complications related to the procedures (endarterectomy or stenting). On the other hand, reperfusion may improve cognitive impairment. The best treatment choice is unclear, considering possible deterioration of cognitive function related to carotid artery stenosis. There is insufficient evidence to consider cognitive impairment an important factor in determining the therapy for carotid stenosis.

Download Full-text

Progression of external and internal carotid artery stenosis is associated with a higher risk of ischemic neurologic events in patients with asymptomatic carotid artery stenosis

Vascular Medicine ◽

10.1177/1358863x17722626 ◽

2017 ◽

Vol 22 (5) ◽

pp. 418-423 ◽

Cited By ~ 3

Author(s):

Reza Masoomi ◽

Zubair Shah ◽

Buddhadeb Dawn ◽

Karthik Vamanan ◽

Aravinda Nanjundappa ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Artery Stenosis ◽

Internal Carotid ◽

Internal Carotid Artery Stenosis ◽

Artery Stenosis ◽

Diagnostic Tools ◽

Asymptomatic Carotid ◽

Increased Risk ◽

Asymptomatic Carotid Artery Stenosis

A small percentage of patients with asymptomatic carotid artery stenosis (ACAS) who are on optimal medical management do go on to develop ischemic stroke or transient ischemic attacks (IS/TIA). Several diagnostic tools have been studied to identify those patients who are at increased risk. However, most of these diagnostic tools are not available for routine clinical use or are resource intensive. We performed a retrospective study to assess the incremental value of external carotid artery stenosis progression (ECASP) along with internal carotid artery stenosis progression (ICASP) in predicting risk of ipsilateral IS/TIA in a cohort of patients with ACAS. We conducted a retrospective analysis of patients with ACAS who had at least two serial duplex ultrasounds (DUS) at our center. A total of 356 patients (712 carotid arteries) were included in the study (mean age 74.7±9 years, 49.2% male) with a mean follow-up of 60.7±32.7 months. In univariate analysis, concurrent progression of ICA and ECA stenosis on the same side arteries was associated with a very significant increased risk of ipsilateral IS/TIA (14.7% vs 4.6%, p<0.001). Also, multivariable regression analysis showed that concurrent ECA/ICA progression was an independent predictor of IS/TIA (OR=3.6, 95% CI 1.64–7.8; p=0.001). ECASP along with ICASP is significantly associated with increased risk of ipsilateral IS/TIA and provides incremental risk stratification over that provided by ICASP alone. The ECA is routinely evaluated in clinical practice, and it could serve as an additional marker for identifying higher risk patients with ACAS.

Download Full-text

Risk stratification of patients with asymptomatic carotid artery stenosis: evaluation of carotid stenosis severity, progression, and morphology by duplex ultrasound

Asymptomatic Carotid Artery Stenosis ◽

10.3109/9780203089859-13 ◽

2007 ◽

pp. 125-136

Keyword(s):

Carotid Artery ◽

Risk Stratification ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Duplex Ultrasound ◽

Artery Stenosis ◽

Asymptomatic Carotid ◽

Stenosis Severity ◽

Asymptomatic Carotid Artery Stenosis

Download Full-text

Effect of carotid endarterectomy on cognitive function in patients with asymptomatic carotid artery stenosis

Acta Neurochirurgica ◽

10.1007/s00701-013-1625-0 ◽

2013 ◽

Vol 155 (4) ◽

pp. 627-633 ◽

Cited By ~ 12

Author(s):

Akiko Takaiwa ◽

Naoya Kuwayama ◽

Naoki Akioka ◽

Kunikazu Kurosaki ◽

Nakamasa Hayashi ◽

...

Keyword(s):

Cognitive Function ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Asymptomatic Carotid ◽

Asymptomatic Carotid Artery Stenosis

Download Full-text

Angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy compared to best medical treatment: One-year interim results of SPACE-2

International Journal of Stroke ◽

10.1177/1747493019833017 ◽

2019 ◽

Vol 15 (6) ◽

pp. 638-649 ◽

Cited By ~ 5

Author(s):

T Reiff ◽

HH Eckstein ◽

U Mansmann ◽

O Jansen ◽

G Fraedrich ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Asymptomatic Carotid Stenosis ◽

Asymptomatic Carotid ◽

Best Medical Treatment ◽

Asymptomatic Carotid Artery Stenosis ◽

One Year ◽

The One

Background Treatment of individuals with asymptomatic carotid artery stenosis is still handled controversially. Recommendations for treatment of asymptomatic carotid stenosis with carotid endarterectomy (CEA) are based on trials having recruited patients more than 15 years ago. Registry data indicate that advances in best medical treatment (BMT) may lead to a markedly decreasing risk of stroke in asymptomatic carotid stenosis. The aim of the SPACE-2 trial (ISRCTN78592017) was to compare the stroke preventive effects of BMT alone with that of BMT in combination with CEA or carotid artery stenting (CAS), respectively, in patients with asymptomatic carotid artery stenosis of ≥70% European Carotid Surgery Trial (ECST) criteria. Methods SPACE-2 is a randomized, controlled, multicenter, open study. A major secondary endpoint was the cumulative rate of any stroke (ischemic or hemorrhagic) or death from any cause within 30 days plus an ipsilateral ischemic stroke within one year of follow-up. Safety was assessed as the rate of any stroke and death from any cause within 30 days after CEA or CAS. Protocol changes had to be implemented. The results on the one-year period after treatment are reported. Findings It was planned to enroll 3550 patients. Due to low recruitment, the enrollment of patients was stopped prematurely after randomization of 513 patients in 36 centers to CEA (n = 203), CAS (n = 197), or BMT (n = 113). The one-year rate of the major secondary endpoint did not significantly differ between groups (CEA 2.5%, CAS 3.0%, BMT 0.9%; p = 0.530) as well as rates of any stroke (CEA 3.9%, CAS 4.1%, BMT 0.9%; p = 0.256) and all-cause mortality (CEA 2.5%, CAS 1.0%, BMT 3.5%; p = 0.304). About half of all strokes occurred in the peri-interventional period. Higher albeit statistically non-significant rates of restenosis occurred in the stenting group (CEA 2.0% vs. CAS 5.6%; p = 0.068) without evidence of increased stroke rates. Interpretation The low sample size of this prematurely stopped trial of 513 patients implies that its power is not sufficient to show that CEA or CAS is superior to a modern medical therapy (BMT) in the primary prevention of ischemic stroke in patients with an asymptomatic carotid stenosis up to one year after treatment. Also, no evidence for differences in safety between CAS and CEA during the first year after treatment could be derived. Follow-up will be performed up to five years. Data may be used for pooled analysis with ongoing trials.

Download Full-text

Correlation between carotid stenosis and cognitive impairment

10.21203/rs.3.rs-17448/v1 ◽

2020 ◽

Author(s):

YAO HUANG ◽

Lanying He ◽

Feng Wang ◽

Yuanye Ma

Keyword(s):

Cognitive Function ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Internal Carotid ◽

Internal Carotid Artery Stenosis ◽

Artery Stenosis ◽

Severe Stenosis ◽

Mild Stenosis

Abstract Background Severe internal carotid artery stenosis significantly affects the cognitive function of patients, but the effect of different degree and different side of stenosis on cognitive function was still controversial.This study aims to investigate the correlation between different degrees and different sides of internal carotid artery stenosis and cognitive impairment.Methods There were 34 patients with internal carotid stenosis and 31 controls without stenosis who underwent CTA, DSA, memory scale and modified WCST. Stenosis group was divided into mild stenosis group (n=15) and moderate-severe stenosis group (n=19) according to the degree of stenosis, and was divided into left stenosis group (n=24) and right stenosis group (n=10) according to the sides. Overall vascular examination results,cognitive function scores were computed and analysised.Results Stenosis group and no-stenosis group did not differ in age,education level, BMI, hyperlipidemia, gender, hypertention, diabetes, smoking drinking and right-handedness.Stenosis group had worse memory scale and modified WCST scores for cognitive function. There were statistically significant differences in memory scale and modified WCST scores between mild stenosis group, moderate-severe stenosis group and no-stenosis group,but no differences between mild stenosis group and moderate-severe stenosis group,no differences between left stenosis group and right stenosis group.Conclusions Internal carotid artery stenosis affects the cognitive function represented by memory and executive ability significantly.

Download Full-text

Oxidative injury associated with stenting of asymptomatic carotid artery stenosis

VASA ◽

10.1024/0301-1526/a000621 ◽

2017 ◽

Vol 46 (4) ◽

pp. 268-274

Author(s):

Erhan Saraçoğlu ◽

Ertan Vuruşkan ◽

Yusuf Çekici ◽

Salih Kiliç ◽

Halil Ay ◽

...

Keyword(s):

Oxidative Stress ◽

Carotid Artery ◽

Oxidative Damage ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Oxidative Stress Marker ◽

Asymptomatic Carotid ◽

Imaging Methods ◽

Neurological Findings ◽

Asymptomatic Carotid Artery Stenosis

Abstract. Background: After carotid artery stenting (CAS), neurological complications that cannot be explained with imaging methods may develop. In our study we aimed to show, using oxidative stress markers, isolated oxidative damage and resulting neurological findings following CAS in patients with asymptomatic carotid artery stenosis. Patients and methods: We included 131 neurologically asymptomatic patients requiring CAS. The neurological findings were evaluated using the modified Rankin Scale (mRS) prior to the procedure, one hour post-procedure, and two days after. Patients with elevated mRS scores but with or without typical hyperintense lesions observed on an MRI and with changes of oxidative stress marker levels at the time (Δtotal-thiol, Δtotal antioxidative status [TAS], and Δtotal oxidant status [TOS]) were evaluated. Results: In the neurological examination carried out one hour prior to the procedure, there were 92 patients with mRS = 0, 20 with mRS = 1, and 12 with mRS = 2. When Δtotal-thiol, ΔTAS, and ΔTOS values and the mRS were compared, it was observed that as the difference in oxidative parameters increased, clinical deterioration also increased proportionally (p = 0.001). Conclusions: We demonstrate a possible correlation between oxidative damage and neurological findings after CAS which could not be explained by routine imaging methods.

Download Full-text

Faculty Opinions recommendation of Patients with severe asymptomatic carotid artery stenosis do not have a higher risk of stroke and mortality after coronary artery bypass surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13360020.14730142 ◽

2011 ◽

Author(s):

Megan Leary ◽

Angela Adams ◽

Jeffrey Veluz

Keyword(s):

Coronary Artery ◽

Carotid Artery ◽

Coronary Artery Bypass ◽

Carotid Artery Stenosis ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Artery Stenosis ◽

Asymptomatic Carotid ◽

Asymptomatic Carotid Artery Stenosis

Download Full-text

Carotid artery stenosis – Current evidence and treatment recommendations

Clinical and Translational Neuroscience ◽

10.1177/2514183x211001654 ◽

2021 ◽

Vol 5 (1) ◽

pp. 2514183X2110016

Author(s):

Mandy D Müller ◽

Leo H Bonati

Keyword(s):

Carotid Artery ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Current Evidence ◽

Asymptomatic Carotid Stenosis ◽

Asymptomatic Carotid ◽

Risk Of Death ◽

Asymptomatic Patients

Background: Carotid artery stenosis is an important cause for stroke. Carotid endarterectomy (CEA) reduces the risk of stroke in patients with symptomatic carotid stenosis and to some extent in patients with asymptomatic carotid stenosis. More than 20 years ago, carotid artery stenting (CAS) emerged as an endovascular treatment alternative to CEA. Objective and Methods: This review summarises the available evidence from randomised clinical trials in patients with symptomatic as well as in patients with asymptomatic carotid stenosis. Results: CAS is associated with a higher risk of death or any stroke between randomisation and 30 days after treatment than CEA (odds ratio (OR) = 1.74, 95% CI 1.3 to 2.33, p < 0.0001). In a pre-defined subgroup analysis, the OR for stroke or death within 30 days after treatment was 1.11 (95% CI 0.74 to 1.64) in patients <70 years old and 2.23 (95% CI 1.61 to 3.08) in patients ≥70 years old, resulting in a significant interaction between patient age and treatment modality (interaction p = 0.007). The combination of death or any stroke up to 30 days after treatment or ipsilateral stroke during follow-up also favoured CEA (OR = 1.51, 95% CI 1.24 to 1.85, p < 0.0001). In asymptomatic patients, there is a non-significant increase in death or stroke occurring within 30 days of treatment with CAS compared to CEA (OR = 1.72, 95% CI 1.00 to 2.97, p = 0.05). The risk of peri-procedural death or stroke or ipsilateral stroke during follow-up did not differ significantly between treatments (OR = 1.27, 95% CI 0.87 to 1.84, p = 0.22). Discussion and Conclusion: In symptomatic patients, randomised evidence has consistently shown CAS to be associated with a higher risk of stroke or death within 30 days of treatment than CEA. This extra risk is mostly attributed to an increase in strokes occurring on the day of the procedure in patients ≥70 years. In asymptomatic patients, there may be a small increase in the risk of stroke or death within 30 days of treatment with CAS compared to CEA, but the currently available evidence is insufficient and further data from ongoing randomised trials are needed.

Download Full-text