Carotid occlusion: Impact of cerebral hemodynamic impairment on cognitive performances

Abstract

The aim of this study was to investigate whether the presence of carotid artery occlusion (CO) may be associated with different cognitive performances in relation to the side of the occlusion and its hemodynamic consequences. Methods: During a 12-month period, 61 asymptomatic patients, 32 with right and 29 with left CO, were enrolled. Each patient underwent an assessment of cerebrovascular reactivity (CVR) to hypercapnia with transcranial Doppler (TCD) ultrasonography using the breath-holding index (BHI). Neuropsychological assessment evaluating performances of the hemisphere ipsilateral to CO were administered at entry (T 0) and then repeated after 2 years (T 1). Results: Scores obtained at colored progressive matrices (CPM) and Rey Complex Figure Copy Test were significantly lower at T 0 in patients with reduced BHI values ipsilateral to CO. Multivariate models showed that reduced BHI values were also associated to a significant decrease from T 0 to T 1 in scores obtained for CPM and Categorical Verbal Fluency tests, respectively, in patients with right (P = 0.002) or left CO (P = 0.004). Conclusions: These findings suggest that hemodynamic alterations could be involved in the reduction in cognitive function regulated by the hemisphere ipsilateral to CO. The assessment of CVR with TCD ultrasonography may be a reliable approach for the individuation of asymptomatic patients with CO at increased risk of cognitive deterioration.

Leptomeningeal collateral activation indicates severely impaired cerebrovascular reserve capacity in patients with symptomatic unilateral carotid artery occlusion

“…This is important not only to prevent recurrent ischemic strokes but also to avoid a cognitive deterioration in the presence of carotid occlusion, especially when associated to impaired CVR. 46,47 For future studies, however, it is important to mention that a validation of the present findings using a sensitivity and specificity analysis would be of utmost clinical importance.…”

Efficacy and safety of reperfusion treatments in middle-old and oldest-old stroke patients

“…These findings can be variously interpreted. Older people present several features that could increase the risk of complications, such as cognitive impairment [ 21 , 22 ], increased fragility of cerebral vessels with reduced extent of penumbra [ 18 ], increased extension of leukoaraiosis [ 19 ], amyloid angiopathy [ 23 ] and impaired neurological reserve [ 24 ]. The variable presence of all these elements could influence the different clinical consequences due to AIS.…”