Effects of carotid revascularization on cognitive function and brain functional connectivity in carotid stenosis patients with cognitive impairment: a pilot study

Kohta, Masaaki; Oshiro, Yasuo; Yamaguchi, Yukuya; Ikeuchi, Yusuke; Fujita, Atsushi; Hosoda, Kohkichi; Tanaka, Kazuhiro; Mizobuchi, Satoshi; Kohmura, Eiji; Sasayama, Takashi

doi:10.3171/2023.1.jns222804

Cited by 1 publication

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“…Increasing evidence suggests that CEA/CAS can lead to neurocognitive improvements. [22][23][24] In patients with severe carotid stenosis, baseline measures of cognitive function may be below the normal levels observed in the general population; 25) however, whether elderly patients experience neurocognitive improvements following CEA/CAS remains controversial. For example, a study by Succar et al suggested that carotid interventions improved cognitive function in younger patients with carotid occlusive atherosclerosis, whereas no cognitive benefits were observed in males above 80 years old.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Carotid Endarterectomy and Carotid Artery Stenting in Older Patients Over 80

KASHIWAZAKI,

HORI,

AKIOKA

et al. 2024

Neurol. Med. Chir.(Tokyo)

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As the average life expectancy increases, neurosurgeons are likely to encounter patients aged 80 years and above with carotid stenosis; however, whether old age affects clinical post-treatment outcomes of carotid endarterectomy (CEA) or carotid artery stenting (CAS) remains inconclusive. Thus, this study aimed to evaluate the outcomes following CEA or CAS in patients aged 80 years and above. This study included older over 80 years (n = 34) and younger patients (<80 years; n = 222) who underwent CEA or CAS between 2012 and 2022. All of them were followed up for a mean of 55 months. All-cause mortality, the incidence of vascular events, ability to perform daily activities, and nursing home admission rates were assessed. During follow-up periods, 34 patients (13.3%) died due to coronary artery disease, malignancy, and pneumonia, and the incidence was significantly higher in the elderly group than in the younger group (P = 0.03; HR, 3.01; 95% CI, 1.53-5.56). The incidence of vascular events did not differ between the older group (29.5%) and the younger group (26.9%, P = 0.58); however, the incidence was significantly higher in patients with high-intensity plaques than in those without that (P = 0.008; HR, 2.83, 95%CI, 1.27-4.87). The decline in the ability to perform daily activities and increased nursing home admission rates were high in elderly patients (P < 0.01). Although the mortality rate was higher in the elderly group, subsequent vascular events were comparable to that in the younger group. The results suggest that CEA and CAS are safe and useful treatments for carotid stenosis in older patients, especially to prevent ipsilateral ischemic stroke.

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