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

Gupta, Avinash; Bhatti, Amit; Shah, Mudasir Mushtaq; Mahajan, Niranjan Prakash; Sadana, Divya; Huded, Vikram

doi:10.5469/neuroint.2020.00038

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…Our results suggest that, for the asymptomatic patients with CAS, revascularization could not only relieve stenosis of the carotid artery, but also, to a certain extent, improve the cognitive impairment. This finding was in line with those of several recent studies ( Gupta et al, 2020 ; Turowicz et al, 2021 ).…”

Section: Discussionsupporting

confidence: 94%

Examination of brain area volumes based on voxel-based morphometry and multidomain cognitive impairment in asymptomatic unilateral carotid artery stenosis

Duan

Li²,

Cui³

et al. 2023

Front. Aging Neurosci.

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ObjectiveRecent evidence has demonstrated that unilateral carotid artery stenosis (CAS) can contribute to the development of cognitive impairment. However, the features of cognitive dysfunction induced by unilateral CAS remain unclear.MethodsSixty asymptomatic patients with unilateral CAS were divided into mild, moderate and severe stenosis groups. These patients and 20 healthy controls provided clinical data and serum, which was used to assess the levels of certain vascular risk factors. Then, they participated in a battery of neuropsychological tests. Additionally, all participants underwent a 3.0 T magnetic resonance imaging (MRI) scan of the brain. Chi-square tests and one-way ANOVA were used to determine significant differences in the risk factors and cognitive test scores between groups. Multiple logistic regression analysis and the receiver operating characteristic (ROC) curve analysis were performed to identify the independent risk factors for cognitive impairment in patients with CAS. Finally, fluid attenuated inversion recovery (FLAIR) T1-weighted MRI images were processed by voxel-based morphometry (VBM) analysis using the Statistical Parametric Mapping (SPM) 8 software.ResultsCompared with healthy controls, the scores of the Mini-Mental State Examination, Digital Span Test backward, and Rapid Verbal Retrieve were significantly reduced in patients with left CAS. The scores in all cognitive scales were significantly lower in patients with right CAS than in controls. Logistic regression analysis demonstrated that the degree of carotid stenosis was an independent risk factor for cognitive impairment in asymptomatic patients with unilateral CAS. Furthermore, VBM analysis showed that, compared with those in healthy controls, gray matter and white matter volumes in specific brain areas were markedly decreased in patients with severe unilateral CAS. However, in patients with moderate right CAS, there was a significant decline in the volume of gray matter in the left parahippocampal gyrus and supplementary motor area. Additionally, the volume of white matter in the left insula was obviously lower in patients with moderate right CAS than in healthy controls.ConclusionUnilateral asymptomatic CAS, especially on the right side, contributed to cognitive impairment, including memory, language, attention, executive function and visuospatial function. In addition, based on VBM analysis, both gray matter atrophy and white matter lesions were found in patients with unilateral asymptomatic CAS.

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Section: Discussionsupporting

confidence: 94%

Examination of brain area volumes based on voxel-based morphometry and multidomain cognitive impairment in asymptomatic unilateral carotid artery stenosis

Duan

Li²,

Cui³

et al. 2023

Front. Aging Neurosci.

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“…Furthermore, in a study including 31 patients, the patients showed improvements in attention, memory, visuospatial, and language. However, as in a previous study, there was no improvement in fluency [ 89 ]. Meanwhile, in a study including 17 patients, the patients showed no improvement in psychomotor speed [ 90 ].…”

Section: Reviewsupporting

confidence: 61%

Medical and Surgical Management of Symptomatic and Asymptomatic Carotid Artery Stenosis: A Comprehensive Literature Review

Mohd,

Alabdallat,

Mohd

et al. 2023

Cureus

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Carotid artery stenosis is a condition where the carotid artery is blocked by fatty cholesterol deposits called plaque, increasing the risk of stroke. Elderly individuals with high cardiovascular risk are more susceptible, along with smokers, those with high cholesterol, males, and older individuals. Young females may also be affected by fibromuscular dysplasia. Carotid stenosis significantly raises stroke risk, and the severity is closely linked to stroke incidence and other cardiovascular events. Early detection and treatment are essential to prevent complications. Treatment options include medical and surgical interventions, such as carotid endarterectomy (CEA) and carotid artery stenting (CAS). The choice between surgery and medical management varies depending on patient characteristics and risk factors. This review explores carotid artery stenosis pathophysiology, risk factors, the importance of early detection and treatment, and the surgical approaches of CEA and CAS, addressing their roles and controversies. Healthcare professionals must understand these aspects to provide optimal care to patients with this condition.

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“…All the studies, except for 1 prospective study, 63 agreed on the evidence of a cognitive improvement after CAS, due to a global cerebral perfusion amelioration. 12, 59,62,65,68,70,74,75 Remarkably, in the studies comparing CAS and endarterectomy, no significant differences in cognitive outcomes between groups were detected. 64,70,72,73 Even the only RCT study in this group demonstrated no differences between CAS and endarterectomy groups in verbal and nonverbal memory, attention, and executive functioning.…”

Section: Resultsmentioning

confidence: 95%

Considering Psychological and Cognitive Factors in Interventional Neuroradiology: A Systematic Literature Review

Riccietti,

Schiavolin,

Caldiera

et al. 2023

AJNR Am J Neuroradiol

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BACKGROUND: Interventional neuroradiology is a relatively recent discipline that diagnoses and treats cerebral vascular diseases. However, specific literature on cognitive and psychological domains of patients undergoing interventional neuroradiology procedures is limited. PURPOSE: Our aim was to review the existent literature on cognitive and psychological domains in patients undergoing interventional neuroradiology procedures to raise clinicians' awareness of their mental status.DATA SOURCES: Articles were searched in PubMed, EMBASE, and Scopus from 2000 to 2022 using terms such as "interventional neuroradiology," "psychology," and "cognition" according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.STUDY SELECTION: Of 1483 articles in English, 64 were included and analyzed. Twelve focused on psychological aspects; 52, on cognitive ones.DATA ANALYSIS: Regarding psychological aspects, it appears that early psychological consultations and "nonpharmacologic" strategies can impact the anxiety and depression of patients undergoing endovascular procedures. Regarding cognitive aspects, it appears that endovascular treatment is safe and generates similar or even fewer cognitive deficits compared with analogous surgical procedures.DATA SYNTHESIS: Among the 12 articles on psychological aspects, 6/12 were retrospective with one, while 6/12 were prospective. Among the 52 articles on cognitive aspects, 7/54 were retrospective, while 45/52 were prospective. LIMITATIONS:The main limitation derives from the inhomogeneity of the cognitive and psychological assessment tools used in the articles included in our analysis. CONCLUSIONS:Our review highlights the need to include cognitive and psychological assessments in clinical practice in case patients eligible for interventional neuroradiology procedures. In the future, much more research of and attention to cognitive and psychologic aspects of neurovascular disease is needed. Systematic incorporation of strategies and tools to access and address pre, peri-, and postprocedural psychological and cognitive components could have major benefits in patient satisfaction, recovery, and the success of endovascular practice.ABBREVIATIONS: CAS ¼ carotid artery stent placement; DAVF ¼ dural arteriovenous fistula; EC ¼ endovascular coiling; INR ¼ interventional neuroradiology; QoL ¼ quality of life; RCT ¼ randomized control trial; RIA ¼ ruptured intracranial aneurysm; SC ¼ surgical clipping; UIA ¼ unruptured intracranial aneurysm

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

Cited by 6 publications

References 21 publications

Examination of brain area volumes based on voxel-based morphometry and multidomain cognitive impairment in asymptomatic unilateral carotid artery stenosis

Examination of brain area volumes based on voxel-based morphometry and multidomain cognitive impairment in asymptomatic unilateral carotid artery stenosis

Medical and Surgical Management of Symptomatic and Asymptomatic Carotid Artery Stenosis: A Comprehensive Literature Review

Considering Psychological and Cognitive Factors in Interventional Neuroradiology: A Systematic Literature Review

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