The impact of carotid revascularization on cognitive function

Abstract

The concept that carotid disease may compromise cognitive function was initially proposed by Fisher in 1951, based on an autopsy case. However, some topics involving cognitive function remain controversial, such as its correlation with carotid obstructive disease. So, the authors of this review evaluate the impact of carotid revascularization on cognitive function and the repercussions of the revascularization technique (carotid stenting vs. endarterectomy) chosen. It was clear from the literature reviewed that carotid stenosis is related to a decline in cognitive function over time. However, controversy still remains over the impact of carotid revascularization on cognitive function. With elation to the technique employed (carotid stenting vs. endarterectomy), the majority of studies found no difference between the two techniques in terms of overall cognitive outcome.Keywords: carotid stenosis; therapy; carotid endarterectomy; cognition. ResumoA noção de que a doença carotídea pode comprometer a função cognitiva foi proposta inicialmente por Fisher, em 1951, baseado em um caso de necropsia. Porém, alguns tópicos envolvendo a função cognitiva permanecem controversos, tais como sua correlação com a doença obstrutiva da carótida. Nesse sentido, os autores desta revisão buscam avaliar o impacto da revascularização carotídea e a repercussão da técnica de revascularização empregada (endarterectomia versus angioplastia carotídea) sobre a função cognitiva. A partir da literatura levantada, ficou claro que as estenoses carotídeas estão relacionadas com o declínio cognitivo ao longo do tempo, mas ainda há controvérsia no que se refere ao impacto da revascularização carotídea sobre a função cognitiva. Quanto à técnica empregada (angioplastia versus endarterectomia carotídeas), a maioria dos estudos não demonstrou distinção entre as duas técnicas quanto ao desfecho cognitivo geral. Palavras R E V I E W A R T I C L EGermano da Paz Oliveira, Ana Terezinha Guillaumon et al. stenting; cognitive changes; cognitive function. Results were restricted to articles published in English.Articles of interest identified by the initial search strategy were first independently assessed by two of the authors. In order to avoid the risk of excluding any studies that could be important to the review, a consensus meeting was held and then both reviewers chose all the titles they had identified as potentially relevant to the object of study, irrespective of whether or not an abstract was available. Once relevant titles had been selected, the full texts of the articles were acquired and each article was assessed against a protocol covering the following topics: study type, sample, type of intervention used, results observed. All longitudinal, prospective and retrospective articles, meta-analyses and review articles that met the criteria were included.Articles not yet published, comments and editorials, case reports and crosssectional studies were all excluded. Articles with very similar content were also excluded, giving priority to th...

Estenose de carótida extracraniana: revisão baseada em evidências

“…Stroke is among the most relevant chronic diseases and is one of the main reasons for hospitalization and death, causing disability in the vast majority of patients, be it total or partial 1 . Apart from this, only the presence of carotid stenosis would already be related to significant cognitive decline 2 . In addition, stroke is the third leading cause of death in the United States and Europe, losing only for coronary artery disease and cancer [3][4][5] .…”