Carotid Revascularization and Its Effect on Cognitive Function: A Prospective Nonrandomized Multicenter Clinical Study

Whooley, Jenna L.; David, Brandon C.; Woo, Henry H.; Hoh, Brian L.; Raftery, Kevin B.; Siddiqui, Adnan H.; Westerveld, Michael; Amin‐Hanjani, Sepideh; Ghogawala, Zoher

doi:10.1016/j.jstrokecerebrovasdis.2020.104702

Cited by 34 publications

(20 citation statements)

References 22 publications

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“…In our research we observed that asymptomatic patients following CEA showed significant improvement of the cognitive performances measured by MMSE. The statistically significant improvement in MMSE scores in the midterm analysis (12 months) supports the hypothesis that the improvements in cerebral perfusion following the CEA procedure led to better cognitive performances and are in line with the findings from literature [7][8][9][10]. Regarding the rs-fMRI analysis, it is noteworthy that our findings are concordant to those found by Wang T et al [14].…”

Section: Discussionsupporting

confidence: 92%

The mid-term effects of carotid endarterectomy on cognition and regional neural activity analyzed with the amplitude of low frequency fluctuations technique

et al. 2021

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Purpose The study aims to evaluate the mid-term effects of carotid endarterectomy (CEA) on cognition and resting-state functional magnetic resonance imaging (rs-fMRI) using the Amplitude of Low Frequency Fluctuations (ALFF) technique. Methods In this observational study, patients eligible for CEA were prospectively included. On the same day, within 1 week of the CEA procedure performed and 12 months after the CEA procedure, all patients underwent (i) an MRI examination for rs-fMRI analysis and (ii) a cognitive evaluation using the Italian version of the Mini-Mental State Examination (MMSE) corrected for age and schooling. Pre-CEA and post-CEA MMSE scores were evaluated using paired sample t-tests, adopting a p-value < 0.05 as statistical threshold. The ALFF technique was used for analyzing the differences between pre-CEA and post-CEA rs-fMRI scans in terms of regional neural activation. This was accomplished by applying non-parametric statistics based on randomization/permutation for cluster-level inferences, adopting a cluster-mass p-value corrected for false discovery < 0.05 for cluster threshold, and a p-uncorrected < 0.01 for the voxel threshold. Results Twenty asymptomatic patients were enrolled. The mean MMSE score resulted improved following CEA procedure (p-value = 0.001). The ALFF analysis identified a single cluster of 6260 voxels of increased regional neural activity following CEA, and no cluster of reduced activity. The majority of voxels covered the right precentral gyrus, the right middle frontal gyrus, and the anterior division of the cingulate gyrus. Conclusion Mid-term cognitive improvements observed after CEA are associated to increased regional neural activity of several cerebral regions.

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Section: Discussionsupporting

confidence: 92%

The mid-term effects of carotid endarterectomy on cognition and regional neural activity analyzed with the amplitude of low frequency fluctuations technique

et al. 2021

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“…After CEA or CAS operation, the ocular vessel densities on both operated and nonoperated sides increased. Previous studies obtained similar results, in which unilateral carotid revascularization improved the cerebral perfusion and metabolism not only of the ipsilateral cerebral hemisphere but also of the contralateral cerebral hemisphere [4,29,30]. In an earlier examination, Lee et al recruited 20 patients with severe carotid stenosis, and OCTA was performed before CAS and one month after that.…”

Section: Discussionmentioning

confidence: 79%

Optical Coherence Tomography Angiography as a Noninvasive Assessment of Cerebral Microcirculatory Disorders Caused by Carotid Artery Stenosis

Zhu

Zhou

et al. 2021

Disease Markers

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Purpose. Using retinal optical coherence tomography angiography (OCTA), we aimed to investigate the changes in important indicators of cerebral microcirculatory disorders, such as the properties of the radial peripapillary capillaries, vascular complexes, and the retinal nerve fiber layer, caused by carotid stenosis and postoperative reperfusion. Methods. In this prospective longitudinal cohort study, we recruited 40 carotid stenosis patients and 89 healthy volunteers in the First Affiliated Hospital of Harbin Medical University (Harbin, China). Eyes with ipsilateral carotid stenosis constituted the experimental group, while the fellow eyes constituted the contralateral eye group. Digital subtraction angiography, CT perfusion imaging (CTP), and OCTA examinations were performed in all subjects. The vessel density of the radial peripapillary capillaries (RPC), superficial retinal vascular complexes (SVC), deep vascular complexes (DVC), choriocapillaris (CC), and the thickness of the retinal nerve fiber layer (RNFL) were assessed. Propensity-matched analysis was undertaken to adjust for covariate imbalances. Intergroup comparative analysis was conducted, and the paired sample t -test was used to evaluate the preoperative and postoperative changes in OCTA variables. Results. The ocular vessel density in the experimental group was significantly lower than that in the control group (RPC: 55.95 vs. 57.24, P = 0.0161 ; SVC: 48.65 vs. 52.22, P = 0.0006 ; DVC: 49.65 vs. 57.50, P < 0.0001 ). Participants with severe carotid stenosis have reduced contralateral ocular vessel density (RPC 54.30; SVC 48.50; DVC 50.80). Unilateral stenosis removal resulted in an increase in vessel density on both sides, which was detected by OCTA on the 4th day (RPC, P < 0.0001 ; SVC, P = 0.0104 ; DVC, P = 0.0104 ). Moreover, the ocular perfusion was consistent with that established by CTP. Conclusion. OCTA can be used for sensitive detection and accurate evaluation of decreased ocular perfusion caused by carotid stenosis and may thus have the potential for application in noninvasive detection of cerebral microcirculation disorders. This trial is registered with NCT04326842.

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“…5 Previous research studies relying on only paperbased/adapted routine neurocognitive tests have been largely conflicting in their results. [6][7][8][9] While some studies have utilized resting-state fMRI [10][11][12] to show functional connectivity changes with CAS, our study has the advantage of using task-phase fMRI to map out specific brain areas associated with memory improvement in patients undergoing CAS.…”

Section: Discussionmentioning

confidence: 99%

“…Current clinical standard evaluates primarily the successful completion of the procedure by assessing correct stent placement and perioperative complications, notably the 30-day stroke rate, myocardial infarction rates and death. 5 Previous research has mostly relied on paper-based cognitive tests to study the cognitive impact of CAS in patients with carotid stenosis without direct measure of brain activity, and revealed conflicting results [6][7][8][9] that suggested either positive 7,8 or negative 6,9 impact of CAS on cognition. Studies that utilized functional magnetic resonance imaging (fMRI) have been conducted at resting-phase and showed functional connectivity changes with CAS.…”

Section: Introductionmentioning

confidence: 99%

Functional MRI evaluation of the effect of carotid artery stenting: a case study demonstrating cognitive improvement

Chinda

Liang

Siu

et al. 2021

Acta Radiologica Open

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Background The narrowing of the carotid arteries with plaque formation represents a major risk factor for ischemic stroke and cognitive impairments. Carotid angioplasty and stenting is a standard clinical treatment to reduce stroke risk. The cognitive effect of carotid angioplasty and stenting remains largely unknown. Purpose This study aims to provide direct evidence of possible effects of carotid angioplasty and stenting on cognition, using task-phase functional magnetic resonance imaging. Material and Methods This study received harmonized institutional ethics board approval (Grant number REB ID =H18-02495/FHREB 2018-058). Two patients had MRI scans pre-carotid angioplasty and stenting and two-month post-carotid angioplasty and stenting. Case 1 had severe (>95%) flow-limiting stenosis in the right carotid artery. Case 2 had 70% non-flow limiting stenosis in the left carotid artery. At each scan, patients completed two functional magnetic resonance imaging sessions while performing a working memory task. Accuracy, reaction time, and brain activation were analyzed for each patient for possible pre-post carotid angioplasty and stenting changes. Results Case 1 showed increased activation in the right (treated-side) frontal and temporal lobes post-carotid angioplasty and stenting; associated with improvements in accuracy (from 58% to 74%) and task completion rate (from 17% to 72%). Case 2 completed the tasks pre- and post-carotid angioplasty and stenting with >90% accuracy, while decreased functional magnetic resonance imaging activation in the contralateral (untreated) hemisphere and mildly increased activation in the left (treated -side) anterior circulation territory were observed post-carotid angioplasty and stenting. Conclusion These cases provided the first task-phase functional magnetic resonance imaging data demonstrating that carotid angioplasty and stenting improved cognitive function in the re-perfused vascular territory. The finding supports the role of carotid angioplasty and stenting in improving cognitive performance beyond reducing stroke risk.

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Carotid Revascularization and Its Effect on Cognitive Function: A Prospective Nonrandomized Multicenter Clinical Study

Cited by 34 publications

References 22 publications

The mid-term effects of carotid endarterectomy on cognition and regional neural activity analyzed with the amplitude of low frequency fluctuations technique

The mid-term effects of carotid endarterectomy on cognition and regional neural activity analyzed with the amplitude of low frequency fluctuations technique

Optical Coherence Tomography Angiography as a Noninvasive Assessment of Cerebral Microcirculatory Disorders Caused by Carotid Artery Stenosis

Functional MRI evaluation of the effect of carotid artery stenting: a case study demonstrating cognitive improvement

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