Cognitive Functions in Patients after Carotid Artery Revascularization—A Narrative Review

Carotid revascularization may lead to improved cognitive function beyond stroke prevention. This article summarizes the conclusions from available studies on the effects of carotid reperfusion procedures on cognitive function. The papers cited used different neuropsychological tests for cognitive assessment, resulting in different methodologies and the results obtained were not always convergent. However, most studies reported an improvement in neurocognitive abilities after both vascular interventions, but a more precise assessment of the specific benefits is still awaited. Clinical determinants to predict the effects of these treatments on cognitive function are still being sought, but results are not yet satisfactory. In view of these studies, carotid stenosis seems to be an independent risk factor for cognitive deterioration, and the main mechanisms responsible are embolism and cerebral hypoperfusion. The aim of this study is to order the knowledge about the effects of carotid artery stenting (CAS) and endarterectomy (CEA) on neurocognitive functions and to verify the usefulness of using these treatments.

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

Stroke ◽

10.1161/str.51.suppl_1.wp474 ◽

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.

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Carotid Artery Stenting and Its Impact on Cognitive Function: A Prospective Observational Study

Neurointervention ◽

10.5469/neuroint.2020.00038 ◽

2020 ◽

Vol 15 (2) ◽

pp. 74-78

Author(s):

Avinash N Gupta ◽

Amit A Bhatti ◽

Mudasir M Shah ◽

Niranjan P Mahajan ◽

Divya K Sadana ◽

...

Keyword(s):

Cognitive Function ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Therapeutic Option ◽

Carotid Revascularization ◽

Single Center Study ◽

Before And After ◽

Delayed Complications ◽

Lost To Follow Up

Purpose: Carotid artery stenting (CAS) has evolved as a first-line therapeutic option for carotid revascularization in indicated patients for stroke prevention, but there is still a lack of data on its effect on cognitive function (CF), especially among Indian patients. To determine the effect of CAS on CF and to study the immediate and delayed complications of CAS in Indian patients.Materials and Methods: This was a prospective, observational, single-center study. CF was assessed using Addenbrooke’s cognitive examination version III (ACE) before and 3 months after stenting. The demographic and clinical parameters were also assessed. A follow-up evaluation after 3 months was done to compare CF and to observe the occurrence of any complications.Results: Out of 31 patients, 3 were lost to follow up. There were no immediate or delayed procedure-related complications. There was a statistically significant improvement in overall ACE score and memory before and after stenting. On subgroup analysis of those with and without strokes, there was a significant improvement in visuospatial function and mean ACE score. Those with left CAS had significant improvement in memory, visuospatial, language, and ACE scores than right CAS.Conclusion: CAS was associated with significant improvement in CF in patients.

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

Journal of Neurosurgery ◽

10.3171/2018.7.jns18404 ◽

2019 ◽

Vol 131 (6) ◽

pp. 1709-1715 ◽

Cited By ~ 2

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)

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Subclinical Carotid Artery Atherosclerosis and Cognitive Function: A Mini-Review

Frontiers in Neurology ◽

10.3389/fneur.2021.705043 ◽

2021 ◽

Vol 12 ◽

Author(s):

Håkon Ihle-Hansen ◽

Hege Ihle-Hansen ◽

Else Charlotte Sandset ◽

Guri Hagberg

Keyword(s):

Risk Factor ◽

Cognitive Impairment ◽

Cognitive Function ◽

Carotid Artery ◽

Independent Risk Factor ◽

Carotid Atherosclerosis ◽

Vascular Risk ◽

Risk Factor Management ◽

Carotid Artery Atherosclerosis ◽

Non Invasive

Carotid artery atherosclerosis, the result of a multitude of vascular risk factors, is a promising marker for use in risk stratification. Recent evidence suggests that carotid artery atherosclerosis affects cognitive function and is an independent risk factor for the development of cognitive impairment. Both atherosclerosis and cognitive impairment develop over a prolonged period (years), and due to the aging population, markers to identify persons at risk are needed. Carotid artery atherosclerosis can easily be visualized using non-invasive ultrasound, potentially enabling early and intensified risk factor management to preserve cognitive function or delay further decline. However, the burden of atherosclerosis and temporal exposure required to pose a risk of cognitive impairment is unclear. This mini-review aims to explore the available evidence on the association between carotid atherosclerosis and cognition, and furthermore identify the remaining gaps in knowledge.

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Outcomes of Carotid Revascularization in Patients with Contralateral Carotid Artery Occlusion

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.12.063 ◽

2021 ◽

Vol 232 (5) ◽

pp. 699-708.e1

Author(s):

Hanaa Dakour-Aridi ◽

Nadin Elsayed ◽

Mahmoud Malas

Keyword(s):

Carotid Artery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Carotid Revascularization

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Outcomes of Carotid Revascularization in Patients with Contralateral Carotid Artery Occlusion

Journal of Vascular Surgery ◽

10.1016/j.jvs.2021.04.007 ◽

2021 ◽

Vol 74 (1) ◽

pp. 335

Author(s):

H. Dabour-Aridi ◽

N. Elsayed ◽

M. Malas

Keyword(s):

Carotid Artery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Carotid Revascularization

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Cerebral vasoconstriction following CEA and the role of conventional cerebral angiography

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000941 ◽

2020 ◽

pp. 10.1212/CPJ.0000000000000941

Author(s):

Azam S. Tolla ◽

Muhammad U. Farooq ◽

Bradly Haveman-Gould ◽

Ghassan Naisan ◽

Philip B. Gorelick

Keyword(s):

Myocardial Infarction ◽

Carotid Artery ◽

Cerebral Hyperperfusion Syndrome ◽

Carotid Revascularization ◽

Cerebral Vasoconstriction ◽

Cerebral Hyperperfusion ◽

Delayed Complication ◽

Reduce Risk ◽

Revascularization Procedures

Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established cerebrovascular procedures to reduce risk of stroke. Complications include stroke, myocardial infarction, and death. A delayed complication following carotid revascularization is cerebral hyperperfusion syndrome (CHS), which can manifest as intracerebral hemorrhage (ICH)[1]. A less common delayed complication of carotid revascularization procedures is reversible cerebral vasoconstriction syndrome (RCVS).

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