Neurocognitive Improvement After Carotid Artery Stenting in Patients With Chronic Internal Carotid Artery Occlusion and Cerebral Ischemia

Abstract

Background and Purpose— Chronic cerebral hypoperfusion may lead to impairment in neurocognitive performance in patients with chronic internal carotid artery occlusion, and the effects of carotid artery stenting on neurocognitive function have been unclear. Methods— We prospectively enrolled 20 chronic internal carotid artery occlusion patients with objective ipsilateral hemisphere ischemia, in whom carotid artery stenting was attempted. Functional assessments, including the National Institutes of Health Stroke Scale, Barthel Index, and a battery of neuropsychological tests, including the Mini-Mental State Examination, Alzheimer Disease Assessment Scale–Cognitive Subtest, verbal fluency, and Color Trail Making A and B, were administered before and 3 months after intervention. Results— Successful recanalization was achieved in 12 of 20 patients (60%). There was no procedural or new cerebral ischemic event, except for 1 intracranial hemorrhage, which occurred during the procedure and had neurologic sequelae; this case was excluded from analysis. The demographics and baseline cognitive performance were similar between the group with a successful outcome (group 1, n=12) and patients who did not (group 2, n=7). Ten of 12 patients in group 1 had improvement in ipsilateral brain perfusion after the procedure, but none in group 2 had improvement. Significant improvement in the scores on the Alzheimer Disease Assessment Scale–Cognitive Subtest (before, 7.7±8.9 versus after, 5.7±7.1; P =0.024), Mini-Mental State Examination (before, 25.8±3.8 versus after, 27.7±2.7; P =0.015), and Color Trail Making A (before, 123.2±68.6 versus after, 99.3±51.5; P =0.017) were found in group 1 but not in group 2. Conclusions— Successful carotid artery stenting improves global cognitive function as well as attention and psychomotor processing speed in patients with chronic internal carotid artery occlusion.

Changes in cerebral hemodynamic and cognitive parameters after external carotid–internal carotid bypass surgery in patients with severe steno-occlusive disease: A pilot study

“…Likewise, significant within group improvement in visual memory and processing speed have been reported in a study in children with Moyamoya disease [22]. Moreover, Lin et al [24] reported significant neurocognitive improvement in psychomotor speed after carotid artery stenting for chronic steno-occlusive disease of ICA in 12 patients compared to those with unsuccessful carotid artery stenting (n = 7).…”

“…The drawback of the previous studies [10,22,24] is the lack of a matched control group to evaluate whether such cognitive improvement could be a result of the natural recovery following stroke or a consequence of the cerebral revascularization procedure. Our pilot study has filled in the gap by comparing the changes in hemodynamic measures and cognition in patients with the controls with severe steno-occlusive disease of ICA or MCA.…”

NADPH Oxidase 1, a Novel Molecular Source of ROS in Hippocampal Neuronal Death in Vascular Dementia

“…VaD is caused by a range of cardiovascular or cerebrovascular conditions, leading to ischemic, hypoperfusive, or hemorrhagic brain lesions that are characterized by loss of cognitive functions (2,27,33,59). Chronic cerebral hypoperfusion (CCH) is strongly related to progressive cognitive decline (23,46). The effect of CCH is not restricted to VaD; it is also one of the early components of AD pathogenesis (56).…”

Letter by Sposato et al Regarding Article, “Neurocognitive Improvement After Carotid Artery Stenting in Patients With Chronic Internal Carotid Artery Occlusion and Cerebral Ischemia”

“…We read with interest the article "Neurocognitive Improvement After Carotid Artery Stenting in Patients With Chronic Internal Carotid Artery Occlusion and Cerebral Ischemia" by Lin et al 1 The authors state that they found an improvement of global cognitive function, attention, and psychomotor processing speed in patients with chronic internal carotid artery occlusion undergoing carotid artery stenting. Similarly, in a recent prospective study, we found an improvement of executive functioning after carotid artery stenting among patients with internal carotid artery stenosis.…”