Cognitive Improvement in Patients with Severe Carotid Artery Stenosis after Transcervical Stenting with Protective Flow Reversal

Abstract

Impaired cognitive function is often reported in patients with carotid artery stenosis. Revascularization by transcervical carotid artery stenting (CAS) with flow reversal is associated with increased cognition regardless of age, asymtomatic status, previous stroke events, baseline brain parenchyma status, and contralateral carotid artery stenosis. The findings of this preliminary prospective study suggest that transcervical CAS and stenting with flow reversal for cerebral protection is a safe technique that will improve, or at least not worsen, cognitive performance.

Neurocognitive Functioning after Carotid Revascularization: A Systematic Review

“…Only 2 [44,45] of the 12 [44,45,46,47,48,49,50,51,52,53,54,55] included studies examining the effects of CAS fulfilled our methodological criteria regarding control groups (table 3; 1 study with a superscript ‘a’ mark and 1 with a superscript ‘b’ mark). Xu et al [45] implemented a relevant control group that underwent a carotid angiography to correct for practice effects.…”

“…For CAS, symptomatic status also does not seem to influence cognitive results [51]. Furthermore, Ortega et al [54] found an improvement in global cognitive score for patients with, as well as without, previous stroke. We can conclude that symptomatic status does not have a clear impact on the NCF after carotid revascularization.…”

“…Grunwald et al [48] and Turk et al [52] found no correlation between the cognitive results and the side of the intervention. On the other hand, Ishihara et al [44] and Ortega et al [54] found differential effects for left and right CAS. Ishihara et al [44] noted that the performance IQ improved after CAS in patients with severe right-sided carotid artery stenosis while the verbal IQ rose after endovascular treatment of the left carotid artery.…”

“…Ishihara et al [44] noted that the performance IQ improved after CAS in patients with severe right-sided carotid artery stenosis while the verbal IQ rose after endovascular treatment of the left carotid artery. Ortega et al [54] found a significant increase in the global cognitive score, more specifically in language, visuospatial function, and information processing for left CAS, while patients with right CAS only presented a (nonsignificant) trend toward global cognitive improvement.…”

Prospective comparison of cognitive effects of carotid endarterectomy versus carotid stenting with flow reversal or distal filters

“…Studies on the cognitive outcome of CASfr by Ortega et al (2013Ortega et al ( , 2014 have shown promising cognitive results-that is, higher postoperative test scores-but in the first study there was no control group, while in the second study normative data were used as a control group to assess cognitive changes after CASfr. Despite the fact that normative data are a good way to evaluate a cognitive performance at one point, they will not lighten the problem of possible confounders such as practice effects.…”