TY - JOUR T1 - Intervention versus Aggressive Medical Therapy for Cognition in Severe Asymptomatic Carotid Stenosis JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 1889 LP - 1897 DO - 10.3174/ajnr.A4798 VL - 37 IS - 10 AU - C.-J. Lin AU - F.-C. Chang AU - K.-H. Chou AU - P.-C. Tu AU - Y.-H. Lee AU - C.-P. Lin AU - P.-N. Wang AU - I.-H. Lee Y1 - 2016/10/01 UR - http://www.ajnr.org/content/37/10/1889.abstract N2 - 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.CAScarotid artery stent placementFAfractional anisotropyFcfunctional connectivityMCImild cognitive impairmentVCINDvascular cognitive impairment no dementia ER -