Statins Reduce Neurologic Injury in Asymptomatic Carotid Endarterectomy Patients

Heyer, Éric; Mergeche, Joanna L.; Bruce, Samuel S.

doi:10.1016/j.jvs.2013.05.038

Cited by 10 publications

(22 citation statements)

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“…11,21 However, none of these variables were significant in the univariate analyses presented here. This discrepancy may be attributable to Type 2 error (that is, false negative) in the present study, or to the nonrandomized selection of patients who underwent preoperative CTA and/or MRA.…”

Section: Discussionmentioning

confidence: 58%

“…The neuropsychometric tests, their scoring, and performance calculations are described in greater detail in previous works. 8,9,11,12,21,27 Statistical analyses were performed with SAS version 9.3 (SAS Institute, Inc. ; clinical presentation (presence or absence of ischemic symptoms of stroke or transient ischemic attack); and duration of CA cross-clamping. In addition, the integrity of the circle of Willis, as determined by the radiographic visibility of these collateral vessels on preoperative CTA and/or MRA, was analyzed as a predictor of interest for eCD.…”

Section: Neuropsychometric Evaluation and Statistical Analysismentioning

confidence: 99%

“…8,9,11,12,21,27 The underlying pathophysiology of this early cognitive dysfunction (eCD) is not completely understood, but data from a number of studies suggest that ischemic injury is a contributing factor, 3,21,31,32 related to hypoperfusion during intraoperative CA cross-clamping and/or to dislodgment of atheroemboli during vessel dissection and plaque removal.…”

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confidence: 99%

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Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy

Sussman¹,

Kellner

Mergeche³

et al. 2014

JNS

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Object Approximately 25% of patients exhibit cognitive dysfunction 24 hours after carotid endarterectomy (CEA). One of the purported mechanisms of early cognitive dysfunction (eCD) is hypoperfusion due to inadequate collateral circulation during cross-clamping of the carotid artery. The authors assessed whether poor collateral circulation within the circle of Willis, as determined by preoperative CT angiography (CTA) or MR angiography (MRA), could predict eCD. Methods Patients who underwent CEA after preoperative MRA or CTA imaging and full neuropsychometric evaluation were included in this study (n = 42); 4 patients were excluded due to intraoperative electroencephalographic changes and subsequent shunt placement. Thirty-eight patients were included in the statistical analyses. Patients were stratified according to posterior communicating artery (PCoA) status (radiographic visualization of at least 1 PCoA vs of no PCoAs). Variables with p < 0.20 in univariate analyses were included in a stepwise multivariate logistic regression model to identify predictors of eCD after CEA. Results Overall, 23.7% of patients exhibited eCD. In the final multivariate logistic regression model, radiographic absence of both PCoAs was the only independent predictor of eCD (OR 9.64, 95% CI 1.43–64.92, p = 0.02). Conclusions The absence of both PCoAs on preoperative radiographic imaging is predictive of eCD after CEA. This finding supports the evidence for an underlying ischemic etiology of eCD. Larger studies are justified to verify the findings of this study. Clinical trial registration no.: NCT00597883 (http://www.clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 58%

Section: Neuropsychometric Evaluation and Statistical Analysismentioning

confidence: 99%

mentioning

confidence: 99%

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Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy

Sussman¹,

Kellner

Mergeche³

et al. 2014

JNS

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“…Data from these patients have been analyzed in other studies for purposes unrelated to this study. [11][12][13] Eligible participants were English speakers and had no Axis I psychiatric disorders. Both asymptomatic and symptomatic patients undergoing CEA were included.…”

Section: Patients Anesthesia and Surgerymentioning

confidence: 99%

“…The Grooved Pegboard test has been used to measure complex motor coordination and has historically been an effective tool for measuring subtle hand deficits of coordination in patients after CEA. 12,13,18 Fine hand coordination is an important outcome to evaluate, because it has significant implications for quality of life. 2,6,18 A previous study assessed fine hand motor functioning in a cohort of HIVpositive patients.…”

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confidence: 99%

Deficits of hand coordination and laterality of carotid endarterectomy

Heyer

Mallon²,

Mergeche³

et al. 2015

JNS

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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.

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Apolipoprotein E-ε4 polymorphism and cognitive dysfunction after carotid endarterectomy

Heyer

Mergeche

Stern

et al. 2014

Journal of Clinical Neuroscience

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Approximately 25% of patients undergoing carotid endarterectomy (CEA) exhibit cognitive dysfunction (CD) 1 day and 1 month after CEA. The apolipoprotein E (apoE)-ε4 polymorphism has been previously identified as a robust independent risk factor for CD 1 month after CEA. We aimed to determine whether the apoE-ε4 polymorphism is also an independent risk factor for CD as early as 1 day after CEA and to confirm the previous findings at 1 month. Patients undergoing elective CEA (n = 411) were enrolled with written informed consent in this follow-up observational study. CD was evaluated via an extensive neuropsychometric battery. apoE-ε4 carriers exhibited significantly more CD 1 day (30.1% versus 17.9%, p = 0.01) and 1 month (25.7% versus 9.8%, p = 0.001) after CEA compared to non-carriers. Multivariate regression models were generated to determine independent predictors of CD. At 1 day, apoE-ε4 was significantly associated with higher risk of CD (odds ratio [OR]: 2.24 [1.29-3.84], p = 0.004), while statin use was significantly associated with lower risk (OR: 0.40 [0.24-0.67], p < 0.001). At 1 month, apoE-ε4 was significantly associated with higher risk of CD (OR: 3.14 [1.53-6.38], p = 0.002), while symptomatic status was significantly associated with lower risk (OR: 0.45 [0.20-0.94], p = 0.03). The apoE-ε4 polymorphism is an independent risk factor for CD as early as 1 day after CEA and is confirmed to be an independent risk factor for CD at 1 month as well.

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Statins Reduce Neurologic Injury in Asymptomatic Carotid Endarterectomy Patients

Cited by 10 publications

References 0 publications

Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy

Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy

Deficits of hand coordination and laterality of carotid endarterectomy

Apolipoprotein E-ε4 polymorphism and cognitive dysfunction after carotid endarterectomy

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