Comparison of Cognitive Function after Carotid Artery Stenting versus Carotid Endarterectomy

Abstract

The effect of carotid artery stenting (CAS) and carotid endarterectomy (CEA) on cognitive function is unclear. Both cognitive improvement and decline have been reported after CAS and CEA. We aimed to compare the changes in postprocedural cognitive function after CAS versus CEA. A systematic qualitative review of the literature was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement for studies evaluating the changes in cognitive function after CAS compared with CEA. Thirteen studies (403 CEAs; 368 CAS procedures) comparing the changes in cognitive function after CEA versus CAS were identified. Most studies did not show significant differences in overall cognitive function or only showed a difference in a single cognitive test between the two procedures. A definitive conclusion regarding the effect of CAS versus CEA on cognitive function was not possible owing to heterogeneity in definition, method, timing of assessment, and type of cognitive tests. For the same reasons, performing a meta-analysis was not feasible. The lack of standardization of specific cognitive tests and timing of assessment of cognitive function after CAS and CEA do not allow for definite conclusions to be drawn. Larger, adequately-powered and appropriately designed studies are required to accurately evaluate the effect of CAS versus CEA on postprocedural cognitive function.

Comparison of domain-specific cognitive function after carotid endarterectomy and stenting

“…This may explain the disparate results present in the literature. 5,9,17 Sophisticated imaging modalities, mainly magnetic resonance or transcranial Doppler studies, hold promise in elucidating the underlying pathophysiologic mechanisms; however, they are currently lacking in standardization with respect to timing after the intervention and technology used.…”

“…Relevant studies on the subject have produced conflicting results, and two recent literature reviews note that the substantial heterogeneity in the published literature does not allow meaningful inferences. 5,9 Some of the limitations of the available work include a lack of a detailed or domain-specific cognitive battery of tests, the analysis of an often mixed symptomatic and asymptomatic patient population, and the use of an observational design that is prone to confounding and other forms of bias.…”

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

“…On the other hand, perioperative microembolization and hypoperfusion with or without postoperative hyperperfusion could inflict cerebral damage and impair cognitive functions (De Rango et al, 2008;Lal et al, 2011). Furthermore, the jury is still out there as to whether CEA or CASdp have a similar impact on a cognitive level (De Rango et al, 2008;Paraskevas, Lazaridis, Andrews, Veith, & Giannoukas, 2014;Plessers et al, 2014). Both cognitive improvement and deterioration have been reported after either technique in 10 to 15% of patients (Plessers et al, 2014).…”

Preoperative and Postoperative Evaluation of New Double Mesh Carotid Stents with Contrast-Enhanced Ultrasound and Diffusion-Weighted Imaging

“…8 In particular, some studies correlate the presence of early microembolizations after CAS with late cognitive decline, even if in a recent review controversial considerations do not clarify the real impact on cognitive functions. 10 To reduce the risk of intraoperative embolizations, 2 novel innovations are still matter of research: new types of embolic protection devices, such as proximal balloon occlusion, 11 and new stent designs. reviewed a multicentre case series of CAS procedures and found an overall significant higher rate of postprocedural neurological events with opencells stents, even if no statistical differences were detected in asymptomatic patients.…”