Cognitive Sequelae of Silent Ischemic Lesions Following Carotid Artery Stenting: Possible Role of Age-Related Moderation

Background: The occurrence of ischemic lesions is common in patients receiving carotid artery stenting (CAS), and most of them are clinically silent. However, few studies have directly addressed the cognitive sequelae of these procedure-related silent ischemic lesions (SILs).Objective: In this study, we attempted to investigate the effects of SILs on cognition using a comprehensive battery of neuropsychological tests.Method: Eighty-five patients with unilateral carotid stenosis and 25 age-matched healthy volunteers participated in this study. Brain MRI was performed within 1 week before and 1 week after CAS to monitor the occurrence of post-CAS SILs. A comprehensive battery tapping reading ability, verbal and non-verbal memory, visuospatial function, manual dexterity, executive function, and processing speed was administered 1 week before and 6 months after CAS. To control for practice effects on repeated cognitive testing, the reliable change index (RCI) derived from the healthy volunteers was used to determine the cognitive changes in patients with carotid stenosis.Results: Among the 85 patients with carotid stenosis, 21 patients received medical treatment (MED group), and procedure-related SILs were noted in 17 patients (SIL+ group) but not observed in 47 patients (SIL– group) after undergoing CAS. Two-way (group × phase) ANOVA revealed that the volunteer group showed improved scores in most cognitive tests while only limited improvement was noted in the SIL– group. The MED and control groups tended to show improvement in the follow-up cognitive testing than the SIL+ group. However, most of the cognitive changes for each patient group did not exceed the upper or lower limits (z = ±1.0) of the RCI.Conclusions: Although the occurrence of procedure-related SILs is common in patients undergoing CAS, their impacts on cognitive changes after CAS may be limited. The practice effect should be taken into consideration when interpreting cognitive changes following CAS.

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Changes in E-Selectin Levels Predict Carotid Stenosis Progression after Carotid Artery Stenting

Current Neurovascular Research ◽

10.2174/1567202615666180319150021 ◽

2018 ◽

Vol 15 (1) ◽

pp. 18-25

Author(s):

Chi-Hung Liu ◽

Tsong-Hai Lee ◽

Pi-Yueh Chang ◽

Chien-Hung Chang ◽

Hsiu-Chuan Wu ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Stenosis ◽

Carotid Artery Stenting

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The Feasibility and Safety of Separate Carotid Artery Stenting Using the Restrict Protective Method for Bilateral Carotid Stenosis

World Neurosurgery ◽

10.1016/j.wneu.2017.03.027 ◽

2017 ◽

Vol 102 ◽

pp. 235-239 ◽

Cited By ~ 3

Author(s):

Tomotaka Ohshima ◽

Ishu Bishnori ◽

Kojiro Ishikawa ◽

Shunsaku Goto ◽

Taiki Yamamoto ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Stenosis ◽

Carotid Artery Stenting ◽

Bilateral Carotid

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Effects of carotid artery stenting on cognitive function in patients with mild cognitive impairment and carotid stenosis

Experimental and Therapeutic Medicine ◽

10.3892/etm.2013.954 ◽

2013 ◽

Vol 5 (4) ◽

pp. 1019-1024 ◽

Cited By ~ 10

Author(s):

YONG CHENG ◽

YAN JIANG WANG ◽

JIA CHUAN YAN ◽

RUI ZHOU ◽

HUA DONG ZHOU

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Function ◽

Carotid Artery ◽

Carotid Stenosis ◽

Carotid Artery Stenting

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Endovascular Advances for Extracranial Carotid Stenosis

Neurosurgery ◽

10.1227/neu.0000000000000223 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S92-S101 ◽

Cited By ~ 1

Author(s):

Jorge L. Eller ◽

Travis M. Dumont ◽

Grant C. Sorkin ◽

Maxim Mokin ◽

Elad I. Levy ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Carotid Stenting ◽

Historical Background ◽

Treatment Modalities ◽

Endovascular Management ◽

The Past

Abstract Carotid artery stenting has become a viable alternative to carotid endarterectomy in the management of carotid stenosis. Over the past 20 years, many trials have attempted to compare both treatment modalities and establish the indications for each one, depending on clinical and anatomic features presented by patients. Concurrently, carotid stenting techniques and devices have evolved and made endovascular management of carotid stenosis safe and effective. Among the most important innovations are devices for distal and proximal embolic protection and new stent designs. This paper reviews these advances in the endovascular management of carotid artery stenosis within the context of the historical background.

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Carotid artery stenting increased short-term risk for stroke or death more than endarterectomy in symptomatic carotid stenosis

Annals of Internal Medicine ◽

10.7326/0003-4819-154-2-201101180-02008 ◽

2011 ◽

Vol 154 (2) ◽

pp. JC1

Author(s):

Graeme J. Hankey

Keyword(s):

Carotid Artery ◽

Carotid Stenosis ◽

Carotid Artery Stenting ◽

Short Term ◽

Symptomatic Carotid ◽

Symptomatic Carotid Stenosis

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Risk factors for hyperperfusion-induced intracranial hemorrhage after carotid artery stenting in patients with symptomatic severe carotid stenosis evaluation

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013998 ◽

2018 ◽

Vol 11 (5) ◽

pp. 474-478 ◽

Cited By ~ 5

Author(s):

Lei Zhang ◽

Dongwei Dai ◽

Zifu Li ◽

Guoli Duan ◽

Yong-wei Zhang ◽

...

Keyword(s):

Risk Factors ◽

Carotid Artery ◽

Carotid Stenosis ◽

Intracranial Hemorrhage ◽

Carotid Artery Stenting ◽

Ct Perfusion ◽

Treatment Strategies ◽

Imaging Features ◽

Anterior Circulation ◽

Total Occlusion

BackgroundAnalyzing risk factors for hyperperfusion-induced intracranial hemorrhage (HICH) after carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis.MethodsThis study retrospectively analyzed clinical data of 210 patients, who had symptomatic severe carotid stenosis (70–99%) and received CAS treatment between June 2009 and June 2015, and evaluated the relationship of HICH with patients’ clinical baseline data, imaging features, and treatment strategies.ResultsSeven patients (3.3%) developed HICH after CAS. The incidence of HICH among patients with near total occlusion was significantly higher than among those without (10.1% vs 0%, P<0.001). Out of the seven, five had no development of either anterior or posterior circulations, and two had no development of anterior circulation and poor development of posterior circulation. Results showed that patients with poor compensation of Willis’ Circle were more likely to develop HICH compared with other patients (P<0.001). All patients received preoperative CT perfusion. TTP index was defined as the TTP ratio between the affected and contralateral side. The results showed that the TTP index was significantly different between the HICH group and non-HICH group (1.15±0.10 vs 1.30±0.15, P<0.001). An analysis of the ROC curve indicated that patients with TTP index >1.22 were more likely to develop HICH compared with other patients (sensitivity 100%, specificity 75.9%).ConclusionsPatients with severe unilateral carotid stenosis, the presence of near total occlusion, poor compensation of Willis’ Circle, and preoperative TTP index>1.22, have a higher risk of developing HICH after CAS.

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