Deficits of hand coordination and laterality of carotid endarterectomy

Abstract

OBJect Neurocognitive performance is used to assess multiple cognitive domains, including motor coordination, before and after carotid endarterectomy (CEA). Although gross motor strength is impaired with ischemia of large cortical areas or of the internal capsule, the authors hypothesize that patients undergoing CEA demonstrate significant motor deficits of hand coordination contralateral to the operative side, which is more clearly manifest in the nondominant hand than in the dominant hand with ischemia of smaller cortical areas. MetHODS The neurocognitive performance of 374 patients was evaluated with a battery of neuropsychometric tests. Both asymptomatic and symptomatic patients undergoing CEA were included. The authors evaluated the patients' dominant and nondominant hand performance on the Grooved Pegboard test, a test of hand coordination, to demonstrate their functional laterality. Neurocognitive dysfunction was evaluated as the difference in performance before and after CEA according to group-rate and event-rate analyses. The z scores were generated for all tests using a reference group of patients who were having simple spine surgery. Dominant and nondominant motor coordination functions were evaluated as raw scores and as calculated z scores. reSultS According to event-rate analysis, significantly more patients undergoing CEA of the opposite carotid artery demonstrated nondominant than dominant hand deficits of coordination (41.2% vs 26.4%, respectively, p = 0.02). Similarly, according to group-rate analysis, in patients undergoing CEA of the opposite carotid artery, raw difference scores from the Grooved Pegboard test reflected greater nondominant than dominant hand deficits of coordination (21.0 ± 54.4 vs 9.7 ± 37.0, respectively, p = 0.02). cOncluSiOnS Patients undergoing CEA of the opposite carotid artery are more likely to demonstrate nondominant than dominant hand deficits of coordination because of greater dexterity in the dominant hand before surgery.Clinical trial registration no.: NCT00597883 (ClinicalTrials.gov) http://thejns.org/doi/abs/10.3171/2014.8.JNS1459KeY WOrDS cerebrovascular disease/stroke; carotid endarterectomy; laterality; motor dysfunction; vascular disorders aBBreviatiOn CEA = carotid endarterectomy.

Easily Screenable Characteristics Associated with Cognitive Improvement and Dysfunction After Carotid Endarterectomy

“…Early cognitive dysfunction was associated with a number of different patient characteristics, medications and genetic alleles: age, diabetes mellitus, statin usage, neurovascular anatomy, and certain alleles of ApoE, phosphodiesterase and complement. 7–12 Of note, we found that statin usage dramatically decreased the incidence of new neurologic findings and eCD after CEA in asymptomatic patients, defined as those patients without a history of previous stroke or transient ischemic attack. This effect was less evident in symptomatic patients.…”

Convergence Analysis of Micro-Lesions (CAML): An approach to mapping of diffuse lesions from carotid revascularization

“…The finding that the region most vulnerable to these lesions was the motor/premotor area (BA 4/6) is consistent with other studies of carotid revascularization. Heyer et al (2015) studied 374 patients undergoing CEA and found that post-procedure changes in hand dexterity were associated with the side of the surgery. Specifically, procedures contralateral to the nondominant hand (e.g.…”

“…Clinically, endovascular procedures are effective means of preventing stroke, and whereas serious associated complications are rare ( Brott, 2010 ), there have been inconsistent studies suggesting these lesions may be linked to subtle post-procedural cognitive decline and increased vulnerability to future cognitive declines ( Aharon-Peretz et al, 2003 ; Fink et al, 2015 ; Ghogawala et al, 2008 ; Heyer et al, 1998 ; Tiemann et al, 2009 ; van Dijk and Kalkman, 2009 ; Wasser et al, 2011 ; Zhou et al, 2017 ; Zhou et al, 2012 ). For example, one large study showed changes in hand dexterity related to side of intervention ( Heyer et al, 2015 ). To identify potentially subtle dysfunction, it is crucial to have highly specific knowledge of which brain systems are affected in order to develop sensitive and focused assessment.…”

Cognitive functions and patterns of brain activity in patients after simultaneous coronary and carotid artery revascularization

“…Data on the influence of the laterality of CA revascularization on adverse neurological outcomes are limited (Bossema et al, 2007 ; Baracchini et al, 2012 ; Heyer et al, 2015 ). The study by Bossema et al ( 2007 ) demonstrated that cognitive changes, measured by neuropsychological tests sensitive to hemispheric specialization, are irrespective of the side of intervention.…”

“…Baracchini et al ( 2012 ) also found no impact of the CEA side on any of the indicators of cognitive performance. Heyer et al ( 2015 ) investigated the relationship between the laterality of CEA and fine hand deficits using the Grooved Pegboard test. The authors demonstrated greater subtle deficits of hand coordination in the non-dominant hand compared to the dominant hand in patients undergoing CEA of the opposite carotid artery.…”