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Influence of carotid artery stenting on cognitive function

  • Functional Neuroradiology
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Abstract

Introduction

There have only been a few studies on cognitive changes in patients with carotid occlusive disease, and the results of these show major discrepancies in the extent to which treatment affects neuropsychological function. We sought to clarify these discrepancies by evaluating the effects of carotid artery stenting (CAS) on the cognitive function.

Methods

Forty-one asymptomatic CAS patients were administered a test battery of neuropsychological tests measuring cognitive speed and memory function before and 3 months after the procedure. A control group was also evaluated. To test for thromboembolic lesions, diffusion-weighted imaging was used.

Results

CAS led to a significant increase in cognitive speed (p < 0.001) but did not afford any change in memory function. This was regardless of the degree or side of stenosis or patient age or gender.

Conclusion

CAS significantly improved functions that involve cognitive speed. Earlier studies did not differentiate between speed and memory tests and thus might have missed these changes. Further studies correlating changes in brain perfusion with increase in cognitive speed are needed.

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References

  1. Ohta H, Nishikawa H, Kimura H, Anayama H, Miyamoto M (1997) Chronic cerebral hypoperfusion by permanent internal carotid ligation produces learning impairment without brain damage in rats. Neuroscience 79(4):1039–1050

    Article  CAS  PubMed  Google Scholar 

  2. Kitagawa K, Oku N, Kimura Y, Yagita Y, Sakaguchi M, Hatazawa J, Sakoda S (2009) Relationship between cerebral blood flow and later cognitive decline in hypertensive patients with cerebral small vessel disease. Hypertens Res 32:816–820

    Article  PubMed  Google Scholar 

  3. Fearn SJ, Hutchinson S, Riding G, Hill-Wilson G, Wesnes K, McCollum CN (2003) Carotid endarterectomy improves cognitive function in patients with exhausted cerebrovascular reserve. Eur J Vasc Endovasc Surg 26(5):529–536

    Article  CAS  PubMed  Google Scholar 

  4. Lunn S, Crawley F, Harrison MJ, Brown MM, Newman SP (1999) Impact of carotid endarterectomy upon cognitive functioning. A systemic review of the literature. Cerebrovasc Dis 9(2):74–81

    Article  CAS  PubMed  Google Scholar 

  5. Moftakhar R, Turk AS, Niemann DB, Hussain S, Rajpal S, Cook T, Geraghty M, Aagaard-Kientitz B, Turski PA, Newman GC (2005) Effects of carotid or vertebrobasilar stent placement on cerebral perfusion and cognition. Am J Neuroradiol 26(7):1772–1780

    PubMed  Google Scholar 

  6. Bakker FC, Klijn CJ, Jennekens-Schinkel A, van der Tweel I, Tulleken CA, Kappelle LJ (2003) Cognitive impairment in patients with carotid artery occlusion and ipsilateral transient ischemic attacks. J Neurol 250(11):1340–1347

    Article  PubMed  Google Scholar 

  7. Kelly MP, Garron DC, David H (1980) Carotid artery disease, carotid endarterectomy and behavior. Arch Neurol 37(12):743–748

    CAS  PubMed  Google Scholar 

  8. Boeke S (1981) The effect of carotid endarterectomy of mental functioning. Clin Neurol Neurosurg 4:209–217

    Article  Google Scholar 

  9. van den Burg W, Saan RJ, Van Zomeren AH, Boontje AH, Haaxma R, Wichmann TE (1985) Carotid endarterectomy: does it improve cognitive or motor functioning? Psychol Med 15(2):341–346

    Article  PubMed  Google Scholar 

  10. Iddon JL, Sahakian BJ, Kirkpatrick PJ (1997) Uncomplicated carotid endarterectomy is not associated with neuropsychological impairment. Pharmacol Biochem Behav 56(4):781–787

    Article  CAS  PubMed  Google Scholar 

  11. Mathiesen EB, Waterloo K, Joakimsen O, Bakke SJ, Jacobsen EA, Bønaa KH (2004) Reduced neuropsychological test performance in asymptomatic carotid stenosis: the Tromso Study. Neurology 62(5):695–701

    Google Scholar 

  12. Hofman A, Ott A, Breteler MM, Bots ML, Slooter AJ, van Harskamp F, van Duijn CN, Van Broeckhoven C, Grobbee DE (1997) Atherosclerotic, apolipoprotein E and prevalence of dementia and Alzheimer’s disease in the Rotterdam Study. Lancet 349(9046):151–154

    Article  CAS  PubMed  Google Scholar 

  13. Johnston SC, O’Meara ES, Manolio TA, Lefkowitz D, O’Leary DH, Goldstein S, Carlson MC, Fried LP, Longstreth WT Jr (2004) Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease. Ann Intern Med 140(4):237–247

    PubMed  Google Scholar 

  14. Fukunaga S, Okada Y, Inoue T, Hattori F, Hirata K (2006) Neuropsychological changes in patients with carotid stenosis after carotid endarterectomy. Eur Neurol 55(3):145–150

    Article  PubMed  Google Scholar 

  15. Brand N, Bossema ER, MvM O et al (2004) Left or right carotid endarterectomy in patients with atherosclerotic disease: ipsilateral effects on cognition? Brain Cogn 54(2):117–123

    Article  CAS  PubMed  Google Scholar 

  16. Sasoh M, Ogasawara K, Kuroda K, Okuguchi T, Terasaki K, Yamadate K, Ogawa A (2003) Effects of EC–IC bypass surgery on cognitive impairment in patients with hemodynamic cerebral ischemia. Surg Neurol 59(6):455–460

    Article  PubMed  Google Scholar 

  17. Tsuda Y, Yamada K, Hayakawa T, Ayada Y, Kawasaki S, Matsuo H (1994) Cortical blood flow and cognition after extracranial-intracranial bypass in a patient with severe carotid occlusive lesions. A three-year follow up study. Acta Neurochir (Wien) 129(3–4):198–204

    Article  CAS  Google Scholar 

  18. Almeida OP, Flicker L (2001) The mind of a failing heart: a systemic review of the association between congestive heart failure and cognitive functioning. Intern Med J 31(5):290–295

    Article  CAS  PubMed  Google Scholar 

  19. Zuccalà G, Onder G, Pedone C, Carosella L, Pahor M, Bernabei R, Cocchi A, GIFA-ONLUS Study Group [Grupo Italiano di Farmacoepidemiologia nell’Anzanio] (2001) Hypotension and cognitive impairment: selective association in patients with heart failure. Neurology 57(11):1986–1992

    PubMed  Google Scholar 

  20. Heyer EJ, DeLaPaz R, Halazun HJ, Rampersad A, Sciacca R, Zurica J, Benvenisty AI, Quest DO, Todd GJ, Lavine S, Solomon RA, Connolly ES Jr (2006) Neuropsychological dysfunction in the absence of structural evidence for cerebral ischemia after uncomplicated carotid endarterectomy. Neurosurgery 58(3):474–480

    PubMed  Google Scholar 

  21. Ogasawara K, Yamadate K, Kobayashi M, Endo H, Fukuda T, Yoshida K, Terasaki K, Inoue T, Ogawa A (2005) Postoperative cerebral hyperperfusion associated with impaired cognitive function in patients undergoing carotid endarterectomy. J Neurosurg 102(1):38–44

    Article  PubMed  Google Scholar 

  22. Jansen C, Sprengers AM, Moll FL, Vermeulen FE, Hamerlijnck RP, van Gijn J, Ackerstaff RG (1994) Prediction of intracerebral haemorrhage after carotid endarterectomy by clinical criteria and intraoperative transcranial Doppler monitoring: results of 233 operations. Eur J Vasc Surg 8(2):220–225

    Article  CAS  PubMed  Google Scholar 

  23. Klijn CJ, Kappelle LJ, Tulleken CA, van Gijn J (1997) Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors. Stroke 28(10):2084–2093

    CAS  PubMed  Google Scholar 

  24. Orlandi G, Fanucchi S, Fioretti C, Acerbi G, Puglioli M, Padolecchia R, Sartucci F, Murri L (2001) Characteristics of cerebral microembolism during carotid stenting and angioplasty alone. Arch Neurol 58:1410–1413

    Article  CAS  PubMed  Google Scholar 

  25. Gerraty RP, Bowser DN, Infeld B, Mitchell PJ, Davis SM (1996) Microemboli during carotid angiography. Association with stroke risk factors or subsequent magnetic resonance imaging changes? Stroke 27:1543–1547

    CAS  PubMed  Google Scholar 

  26. Rosenkranz M, Fiehler J, Niesen W, Waiblinger C, Eckert B, Wittkugel O, Kucinski T, Rother J, Zeumer H, Weiller C, Sliwka U (2006) The amount of solid cerebral microemboli during carotid stenting does not relate to the frequency of silent ischemic lesions. AJNR Am J Neuroradiol 27(1):157–161

    CAS  PubMed  Google Scholar 

  27. Poppert H, Wolf O, Resch M, Theiss W, Schmidt-Thieme T, Graefin von Einsiedel H, Heider P, Martinoff S, Sander D (2004) Differences in number, size and location of intracranial microembolic lesions after surgical versus endovascular treatment without protection device of carotid artery stenosis. J Neurol 251:1198–1203

    Article  PubMed  Google Scholar 

  28. Barth A, Remonda L, Lovblad KO, Schroth G, Seiler RW (2000) Silent cerebral ischemia detected by diffusion-weighted MRI after carotid endarterectomy. Stroke 31:1824–1828

    CAS  PubMed  Google Scholar 

  29. Kastrup A, Groschel K, Krapf H, Brehm BR, Dichgans J, Schulz JB (2003) Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke 34:813–819

    Article  PubMed  Google Scholar 

  30. Gossetti B, Gattuso R, Irace L, Faccenna F, Venosi S, Bozzao L, Fiorelli M, Andreoli R, Gossetti C (2007) Embolism to the brain during carotid stenting and surgery. Acta Chir Belg 107(2):151–154

    CAS  PubMed  Google Scholar 

  31. Lövblad KO, Plüschke W, Remonda L, Gruber-Wiest D, Do DD, Barth A, Kniemeyer HW, Bassetti C, Mattle HP, Schroth G (2000) Diffusion-weighted MRI for monitoring neurovascular interventions. Neuroradiology 42(2):134–138

    Article  PubMed  Google Scholar 

  32. Grunwald IQ, Papanagiotou P, Roth C, Fassbender K, Karp K, Krick C, Schieber H, Müller M, Haass A, Reith W (2009) Lesion load in unprotected carotid artery stenting. Neuroradiology 51(5):313–317

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department for Diagnostic and Interventional Neuroradiology, Saarland University Clinic, Homburg, Germany

    Iris Quasar Grunwald, Panagiotis Papanagiotou, Martin Backens, Maria Politi, Verena Vedder & K. Zercher

  2. Clinic for Neurology, Saarland University Clinic, Homburg, Germany

    Wolfgang Reith, Tilman Supprian, B. Muscalla, Anton Haass & Christoph M. Krick

  3. Clinic for Psychiatry and Psychotherapy, Saarland University Clinic, Homburg, Germany

    Wolfgang Reith, Tilman Supprian, B. Muscalla, Anton Haass & Christoph M. Krick

  4. Department of Neuroradiology, Homburg, 66424, Germany

    Iris Quasar Grunwald

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  1. Iris Quasar Grunwald
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  2. Panagiotis Papanagiotou
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  3. Wolfgang Reith
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Correspondence to Iris Quasar Grunwald.

Additional information

Iris Quasar Grunwald and Panagiotis Papanagiotou contributed equally to this work.

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Grunwald, I.Q., Papanagiotou, P., Reith, W. et al. Influence of carotid artery stenting on cognitive function. Neuroradiology 52, 61–66 (2010). https://doi.org/10.1007/s00234-009-0618-4

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  • DOI: https://doi.org/10.1007/s00234-009-0618-4

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