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Research ArticleEXTRACRANIAL VASCULAR
Open Access

Intervention versus Aggressive Medical Therapy for Cognition in Severe Asymptomatic Carotid Stenosis

C.-J. Lin, F.-C. Chang, K.-H. Chou, P.-C. Tu, Y.-H. Lee, C.-P. Lin, P.-N. Wang and I.-H. Lee
American Journal of Neuroradiology October 2016, 37 (10) 1889-1897; DOI: https://doi.org/10.3174/ajnr.A4798
C.-J. Lin
aFrom the Departments of Neurology (C.-J.L., P.-N.W., I.-H.L.)dInstitute of Brain Science (C.-J.L., P.-C.T., I.-H.L.)
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F.-C. Chang
bRadiology (F.-C.C.)
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K.-H. Chou
eInstitute of Neuroscience (K.-H.C., C.-P.L.)
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P.-C. Tu
cMedical Education and Research (P.-C.T.), Taipei Veterans General Hospital, Taipei, TaiwandInstitute of Brain Science (C.-J.L., P.-C.T., I.-H.L.)
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Y.-H. Lee
fDepartment and Institute of Physiology (Y.-H.L.)
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C.-P. Lin
eInstitute of Neuroscience (K.-H.C., C.-P.L.)
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P.-N. Wang
aFrom the Departments of Neurology (C.-J.L., P.-N.W., I.-H.L.)gSchool of Medicine (P.-N.W.), National Yang-Ming University, Taipei, Taiwan.
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I.-H. Lee
aFrom the Departments of Neurology (C.-J.L., P.-N.W., I.-H.L.)dInstitute of Brain Science (C.-J.L., P.-C.T., I.-H.L.)
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Abstract

BACKGROUND AND PURPOSE: Asymptomatic carotid stenosis of ≥70% increases the incidence of microembolism and/or chronic hypoperfusion, which may consequently impair neurocognition and brain connections. We sought controlled evidence for any cognitive benefit of aggressive medical therapy and combined carotid revascularization.

MATERIALS AND METHODS: Patients with asymptomatic, unilateral, ≧70% stenosis of the extracranial ICA chose either aggressive medical therapy alone or in combination with carotid artery stent placement in this nonrandomized controlled study. They were examined with a battery of neuropsychological tests, structural MR imaging, DTI, and resting-state fMRI before and 3 months after treatment.

RESULTS: Forty patients were included with 15 in the medical group and 25 in the stent-placement group. Among them, 13 and 21 in the respective groups completed neuroimaging follow-up. The baseline characteristics and the changes in cognitive performance during 3 months showed no differences between treatment groups. Nevertheless, compared with the medical group, the stent-placement group showed subjective dizziness alleviation (P = .045) and a small increase in fractional anisotropy at the splenium of the corpus callosum and the posterior periventricular white matter ipsilateral to carotid artery stent placement. Moreover, only the stent-placement group showed interval improvement in immediate memory and visuospatial performance, which was accompanied by an increase of functional connectivity at the insular cortex of the dorsal attention network and the medial prefrontal cortex of the default mode network.

CONCLUSIONS: Both aggressive medical therapy alone and combined carotid revascularization in ≧70% asymptomatic carotid stenosis similarly preserved cognition during 3-month follow-up, though the latter had the potential for dizziness alleviation and cognitive and connectivity enhancement.

ABBREVIATIONS:

CAS
carotid artery stent placement
FA
fractional anisotropy
Fc
functional connectivity
MCI
mild cognitive impairment
VCIND
vascular cognitive impairment no dementia
  • © 2016 by American Journal of Neuroradiology

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American Journal of Neuroradiology: 37 (10)
American Journal of Neuroradiology
Vol. 37, Issue 10
1 Oct 2016
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Intervention versus Aggressive Medical Therapy for Cognition in Severe Asymptomatic Carotid Stenosis
C.-J. Lin, F.-C. Chang, K.-H. Chou, P.-C. Tu, Y.-H. Lee, C.-P. Lin, P.-N. Wang, I.-H. Lee
American Journal of Neuroradiology Oct 2016, 37 (10) 1889-1897; DOI: 10.3174/ajnr.A4798

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Intervention versus Aggressive Medical Therapy for Cognition in Severe Asymptomatic Carotid Stenosis
C.-J. Lin, F.-C. Chang, K.-H. Chou, P.-C. Tu, Y.-H. Lee, C.-P. Lin, P.-N. Wang, I.-H. Lee
American Journal of Neuroradiology Oct 2016, 37 (10) 1889-1897; DOI: 10.3174/ajnr.A4798
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