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Du B, Wu P, Yin S, Cao S, Mo Y, Liu Y, Zhang Y, Qiu B, Wu X, Hu P, Wei L, Wang K, Wei Q. Intracranial Atherosclerotic Stenosis Is Associated with Cognitive Impairment in Patients with Nondisabling Ischemic Stroke: A pCASL-Based Study. Brain Connect 2023; 13:508-518. [PMID: 37128178 DOI: 10.1089/brain.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Background: Intracranial atherosclerotic stenosis (ICAS) is a key risk factor for vascular cognitive impairment. Cerebral blood flow (CBF) and the spatial coefficient of variation (sCoV) of CBF images (based on pseudocontinuous arterial spin labeling) are used to explore abnormal cerebral perfusion. We aimed to probe the mechanisms underlying cognitive impairment in patients with nondisabling anterior circulation macrovascular disease. Methods: This study included 47 patients with ICAS or occlusion and 40 controls. All participants underwent global and individual neuropsychology assessments and magnetic resonance imaging scan. The correlations between cognitive function and abnormal perfusion were explored. Results: The CBF in the ipsilateral middle cerebral artery (MCA) territory of the lesion side decreased significantly, while it increased on the contralateral side. CBF value had a significant correlation with the memory function in the right cerebral artery lesion group. The sCoV in both gray matter (GM) and the ipsilateral MCA territory of the lesion increased significantly. The sCoV value based on the GM territory or MCA territory was significantly correlated with global cognitive function, memory function, and executive function in patients with ICAS. Conclusions: The cognitive function of patients with severe ICAS or occlusion in anterior circulation was significantly impaired. sCoV could be a better indicator of cognitive impairment than CBF. Interventions to relieve vascular stenosis or occlusion and delay cognitive impairment or improve cognitive function should be actively considered.
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Affiliation(s)
- Baogen Du
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Pan Wu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Shanshan Yin
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Shanshan Cao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Yuting Mo
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Yuanyuan Liu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Ying Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Bensheng Qiu
- Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Xingqi Wu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui, China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui, China
| | - Ling Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Qiang Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui, China
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Mohd AB, Alabdallat Y, Mohd OB, Ghannam RA, Sawaqed S, Hasan H, Ellebedy M, Turkmani K, Al-Ezzi S. Medical and Surgical Management of Symptomatic and Asymptomatic Carotid Artery Stenosis: A Comprehensive Literature Review. Cureus 2023; 15:e43263. [PMID: 37692579 PMCID: PMC10491926 DOI: 10.7759/cureus.43263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Carotid artery stenosis is a condition where the carotid artery is blocked by fatty cholesterol deposits called plaque, increasing the risk of stroke. Elderly individuals with high cardiovascular risk are more susceptible, along with smokers, those with high cholesterol, males, and older individuals. Young females may also be affected by fibromuscular dysplasia. Carotid stenosis significantly raises stroke risk, and the severity is closely linked to stroke incidence and other cardiovascular events. Early detection and treatment are essential to prevent complications. Treatment options include medical and surgical interventions, such as carotid endarterectomy (CEA) and carotid artery stenting (CAS). The choice between surgery and medical management varies depending on patient characteristics and risk factors. This review explores carotid artery stenosis pathophysiology, risk factors, the importance of early detection and treatment, and the surgical approaches of CEA and CAS, addressing their roles and controversies. Healthcare professionals must understand these aspects to provide optimal care to patients with this condition.
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Affiliation(s)
- Ahmed B Mohd
- Faculty of Medicine, Hashemite University, Zarqa, JOR
| | | | - Omar B Mohd
- Faculty of Medicine, Hashemite University, Zarqa, JOR
| | | | - Seri Sawaqed
- Infectious Disease, Faculty of Medicine, Hashemite University, Zarqa, JOR
| | - Hanan Hasan
- Medical Laboratory, The Lab Medical Laboratories, Amman, JOR
| | | | | | - Shakir Al-Ezzi
- Internal Medicine, Hospital Corporation of America (HCA) Medical City Arlington, Dallas, USA
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Cognitive Functions after Carotid Artery Stenting-1-Year Follow-Up Study. J Clin Med 2022; 11:jcm11113019. [PMID: 35683407 PMCID: PMC9180931 DOI: 10.3390/jcm11113019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/29/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The revascularization of carotid arteries minimizes the risk of future cerebral stroke and usually improves cognitive functions. The aim of this study was to assess changes in cognitive function and verify the hypothesis assuming an improvement of selected cognitive functions—psychomotor speed, visuospatial episodic memory, executive function and verbal fluency—in patients after carotid artery stenting during a 12-month follow-up. Methods: 47 persons subject to CAS, including 13 symptomatic persons, were examined before and 12 months after a procedure with a psychological test battery (digit symbol test—DS, Rey–Osterrieth complex figure test—ROCF, Wisconsin Card Sorting Test—WCST, letter verbal fluency—LVF). Sociodemographic data and clinical parameters were acquired from an author questionnaire. Results: The one-year follow-up, after the performed CAS procedure, demonstrated a significant improvement of psychomotor speed, visuospatial episodic memory, and executive function. No changes in the area of verbal fluency or decline in any of cognitive functions under analysis were observed. Conclusions: Carotid artery stenting improves cognitive functioning, both in the area of basic and more complex cognitive functions in persons with carotid atherosclerosis.
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Košťál P, Mrhálek T, Kajanová A, Bombic M, Kubále J, Šterba L, Ostrý S, Fiedler J. Changes in Cognition and Hemodynamics 1 Year after Carotid Endarterectomy for Asymptomatic Stenosis. J Neurol Surg A Cent Eur Neurosurg 2021; 82:505-511. [PMID: 33583008 DOI: 10.1055/s-0040-1720985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The impact of a change in hemodynamics on cognitive skills in patients with asymptomatic carotid stenosis (ACS) after carotid endarterectomy (CEA) remains unclear. The aim of this study was to evaluate the results of CEA for ACS at 1 year by assessing the changes in anterior, middle, and posterior cerebral artery blood flow in tandem with changes in cognitive efficiency. METHODS Flow volume in cerebral arteries using quantitative magnetic resonance angiography was measured in a group of 14 males and 5 females before and at 1 year after CEA for ACS. Cognitive efficiency was assessed by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The values of flow volume were processed using simple ratio (SR) and were used for covariance analyses with changes in cognitive skills after CEA. RESULTS A significant improvement in cognitive efficiency indexes of immediate memory and visuospatial perception at 1 year after CEA for ACS was observed. Simultaneously, a significant deterioration of speech index was noted. During the analysis of association between flow and cognition, the highest correlation could be seen between the middle cerebral artery (MCA) flow and the visuospatial perception. A change in posterior cerebral artery (PCA) flow was associated with an increase in immediate memory index and anterior cerebral artery (ACA) flow change with the speech index. CONCLUSION Convergence of data supporting the association between revascularization and cognitive improvement were added in a small, single-center cohort of ACS patients undergoing CEA. No significant differences in cognition were seen between preoperative findings and at 1 year after CEA. Visuospatial perception improvement was linked to flow change in MCA, immediate memory improvement to flow change in PCA, and speech index change to flow change in ACA. Methodical limitations of this small study preclude formulating larger generalizations. Hemodynamic factors in CEA should be assessed in a larger-scale study.
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Affiliation(s)
- Petr Košťál
- Department of Neurosurgery, Hospital České Budějovice, České Budějovice, Czech Republic.,Department of Neurosurgery, University Hospital Plzeň, Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Tomáš Mrhálek
- Department of Pedagogy and Psychology, University of South Bohemia, České Budějovice, Czech Republic
| | - Alena Kajanová
- Institute of Social and Special-pedagogical Sciences, University of South Bohemia, České Budějovice, Czech Republic
| | - Martin Bombic
- Department of Neurosurgery, Hospital České Budějovice, České Budějovice, Czech Republic.,Department of Neurosurgery, University Hospital Brno, Medical School of Masaryk University in Brno, Brno, Czech Republic
| | - Jiří Kubále
- Department of Radiology, Hospital České Budějovice, České Budějovice, Czech Republic
| | - Luděk Šterba
- Department of Radiology, Hospital České Budějovice, České Budějovice, Czech Republic
| | - Svatopluk Ostrý
- Department of Neurology, Hospital České Budějovice, České Budějovice, Czech Republic.,Department of Neurosurgery and Neurooncology, 1st Medical School of Charles University in Prague and Military Hospital in Prague, Prague, Czech Republic.,Institute of Physiotherapy and Selected Medical Disciplines, Faculty of Health and Social Studies, University of South Bohemia in České Budějovice, České Budějovice, Czech Republic
| | - Jiří Fiedler
- Department of Neurosurgery, Hospital České Budějovice, České Budějovice, Czech Republic.,Department of Neurosurgery, University Hospital Plzeň, Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
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Gupta AN, Bhatti AA, Shah MM, Mahajan NP, Sadana DK, Huded V. Carotid Artery Stenting and Its Impact on Cognitive Function: A Prospective Observational Study. Neurointervention 2020; 15:74-78. [PMID: 32268720 PMCID: PMC7412656 DOI: 10.5469/neuroint.2020.00038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/01/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Carotid artery stenting (CAS) has evolved as a first-line therapeutic option for carotid revascularization in indicated patients for stroke prevention, but there is still a lack of data on its effect on cognitive function (CF), especially among Indian patients. To determine the effect of CAS on CF and to study the immediate and delayed complications of CAS in Indian patients. MATERIALS AND METHODS This was a prospective, observational, single-center study. CF was assessed using Addenbrooke's cognitive examination version III (ACE) before and 3 months after stenting. The demographic and clinical parameters were also assessed. A follow-up evaluation after 3 months was done to compare CF and to observe the occurrence of any complications. RESULTS Out of 31 patients, 3 were lost to follow up. There were no immediate or delayed procedure-related complications. There was a statistically significant improvement in overall ACE score and memory before and after stenting. On subgroup analysis of those with and without strokes, there was a significant improvement in visuospatial function and mean ACE score. Those with left CAS had significant improvement in memory, visuospatial, language, and ACE scores than right CAS. CONCLUSION CAS was associated with significant improvement in CF in patients.
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Affiliation(s)
- Avinash N Gupta
- Department of Neurology, Narayana Institute of Neurosciences, Bengaluru, India
| | - Amit A Bhatti
- Department of Neurology, Narayana Institute of Neurosciences, Bengaluru, India
| | - Mudasir M Shah
- Department of Neurology, Narayana Institute of Neurosciences, Bengaluru, India
| | - Niranjan P Mahajan
- Department of Neurology, Narayana Institute of Neurosciences, Bengaluru, India
| | - Divya K Sadana
- Department of Neuropsychology, Narayana Institute of Neurosciences, Bengaluru, India
| | - Vikram Huded
- Department of Neurology, Narayana Institute of Neurosciences, Bengaluru, India
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Derdeyn CP. Hemodynamics and oxygen extraction in chronic large artery steno-occlusive disease: Clinical applications for predicting stroke risk. J Cereb Blood Flow Metab 2018; 38:1584-1597. [PMID: 28925313 PMCID: PMC6125965 DOI: 10.1177/0271678x17732884] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depending on the adequacy of collateral sources of blood flow, arterial stenosis or occlusion may lead to reduced perfusion pressure and ultimately reduced blood flow in the distal territory supplied by that vessel. There are two well-defined compensatory mechanisms to reduced pressure or flow - autoregulatory vasodilation and increased oxygen extraction fraction. Other changes, such as metabolic downregulation, are likely. The positive identification of autoregulatory vasodilation and increased oxygen extraction fraction in humans is an established risk factor for future ischemic stroke in some disease states such as atherosclerotic carotid stenosis and occlusion. The mechanisms by which ischemic stroke may occur are not clear, and may include an increased vulnerability to embolic events. The use of hemodynamic assessment to identify patients with occlusive vasculopathy at an increased risk for stroke is very appealing for several different patient populations, such as those with symptomatic intracranial atherosclerotic disease, moyamoya phenomenon, complete internal carotid artery occlusion, and asymptomatic cervical carotid artery stenosis. While there is very good data for stroke risk prediction in some of these groups, no intervention based on these tools has been proven effective yet. In this manuscript, we will review these topics above and identify areas for future research.
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Affiliation(s)
- Colin P Derdeyn
- Departments of Radiology and Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Omran J, Mahmud E, White CJ, Aronow HD, Drachman DE, Gray W, Abdullah O, Abu-Fadel M, Firwana B, Mishkel G, Al-Dadah AS. Proximal balloon occlusion versus distal filter protection in carotid artery stenting: A meta-analysis and review of the literature. Catheter Cardiovasc Interv 2017; 89:923-931. [PMID: 27862881 DOI: 10.1002/ccd.26842] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/08/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Carotid artery stenting (CAS) is typically performed using embolic protection devices (EPDs) as a means to reduce the risk of procedure-related stroke. In this study, we compared procedural morbidity and mortality associated with distal (D-EPD) vs. proximal (P-EPD) protection. METHODS MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January 1998 through May 2015. Only studies comparing (D-EPD) and (P-EPD) were included. Two independent reviewers selected and appraised studies and extracted data in duplicate. Random-effects meta-analysis was used to pool outcomes across studies. Heterogeneity of treatment effect among studies was assessed using the I2 statistics. Publication bias was assessed using inspection of funnel plots. The primary endpoints included 30-day mortality and stroke. Secondary endpoints included new cerebral lesions on diffusion-weighted magnetic resonance imaging (DW-MRI) and contralateral lesions on DW-MRI. RESULTS A total of 12,281 patients were included from 18 studies (13 prospective and 5 retrospective) comparing (D-EPD) and (P-EPD) in the setting of CAS. The mean patient age was 69 years and 64% of patients were male. No evidence of publication bias was detected. There was no significant difference between the two modalities in terms of the risk of stroke (risk difference [RD] 0.0, 95% confidence interval [CI] -0.01 to 0.01) or mortality (RD 0.0, 95% CI -0.01 to 0.01) nor was there any difference in the incidence of new cerebral lesions on DW-MRI or contralateral DW-MRI lesions. CONCLUSIONS In patients undergoing CAS, both D-EPD and P-EPD provide similar levels of protection from peri-procedural stroke and 30 days mortality. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jad Omran
- Cardiovascular Medicine Department, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | | | - Herbert D Aronow
- Lifespan Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Douglas E Drachman
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - William Gray
- Lankenau Heart Institute, Wynnewood, Pennsylvania
| | - Obai Abdullah
- Cardiovascular Medicine Department, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Mazen Abu-Fadel
- Section of Cardiovascular Disease, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Belal Firwana
- Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, AR
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Yoon BA, Sohn SW, Cheon SM, Kim DH, Cha JK, Yi S, Park KW. Effect of carotid artery stenting on cognitive function in patients with carotid artery stenosis: a prospective, 3-month-follow-up study. J Clin Neurol 2015; 11:149-56. [PMID: 25851893 PMCID: PMC4387480 DOI: 10.3988/jcn.2015.11.2.149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Carotid artery stenting (CAS) is emerging as an alternative to carotid endarterectomy for the treatment of carotid artery stenosis (CS), but the effect of CAS on the cognitive function of patients with severe CS has not been fully investigated. The aim of this study was to use comprehensive neuropsychological tests to determine the effect of CAS on cognitive function from baseline to 3 months postprocedure in patients with severe CS. Methods Thirty-one patients due to undergo CAS due to high-grade CS (≥70%) and 11 control subjects who were diagnosed with CS, but who did not undergo CAS, and who visited the clinic or emergency room between February 2009 and February 2012 were recruited consecutively at baseline (i.e., pre-CAS). Follow-up neuropsychological evaluations after 3 months were completed by 23 of the 31 patients who underwent CAS, and by 10 of the 11 control subjects. The primary cognitive outcome was assessed using a neuropsychological test containing subcategories designed to test general cognitive function, attention, visuospatial function, language and related functions, memory, and frontal lobe/executive function. Results Of the 23 patients undergoing CAS who completed the 3-month follow-up tests, 12 had asymptomatic CS. During the 3-month follow-up period, the patients who underwent CAS and those with asymptomatic CS achieved similar results to the control group on all cognitive tests. However, symptomatic CS patients (n=11) who underwent CAS exhibited improvements in visuospatial function (p=0.046) and total Seoul Neuropsychological Screening Battery-Dementia Version scores (p=0.010) in comparison with both the asymptomatic CS patients and the control group. Conclusions The findings of this study suggest that CAS has a positive effect on cognitive function in patients with symptomatic CS over a 3-month follow-up period. A long-term, multicenter, prospective case-control study would be helpful to predict quality of life and prognoses for patients undergoing CAS.
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Affiliation(s)
- Byeol A Yoon
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Sang Wuk Sohn
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Sang Myung Cheon
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Dae Hyun Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea.; Busan-Ulsan Regional Cardio-Cerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Jae Kwan Cha
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea.; Busan-Ulsan Regional Cardio-Cerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Sojeong Yi
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea.; Dong-A Anti-aging Research Institute, Dong-A University College of Medicine, Busan, Korea.
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Antonopoulos CN, Kakisis JD, Sfyroeras GS, Moulakakis KG, Kallinis A, Giannakopoulos T, Liapis CD. The impact of carotid artery stenting on cognitive function in patients with extracranial carotid artery stenosis. Ann Vasc Surg 2015; 29:457-69. [PMID: 25591487 DOI: 10.1016/j.avsg.2014.10.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 10/10/2014] [Accepted: 10/27/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND The effect of carotid artery stenting (CAS) on cognitive function in patients with extracranial carotid artery stenosis is equivocal. The aim of this study was to examine the impact of CAS on various domains of cognitive function. METHODS We performed a meta-analysis of the studies evaluating various domains of cognitive function before and after CAS, namely, (1) global cognition using Mini-Mental State Examination (MMSE) and Rey Auditory Verbal Learning Test (RAVLT), (2) executive function using Trail Making Test (TMT) A or Color Trails Test (CTT) A and TMT B or CTT B, (3) language ability using Boston Naming Test (BNT), (4) memory, (5) attention/psychomotor speed, and (6) functional ability, using various cognitive tests. Pooled weighted mean differences (WMDs) and standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were appropriately calculated using fixed or random effects models after assessing between-study heterogeneity. Meta-regression analysis was performed with number of patients per study; mean age (years); follow-up (months); proportion of men; proportion of patients with hypertension, diabetes mellitus, hyperlipidemia, smoking, and coronary artery disease; proportion of symptomatic patients; and degree of ipsilateral and degree of contralateral carotid stenosis as covariates. RESULTS Sixteen studies were eligible, including a total of 626 CAS patients. A statistically significant improvement of global cognition was detected with MMSE (WMD = 0.67, 95% CI = 0.29-1.05, P < 0.001; follow-up = 5.6 months), but not with RAVLT (SMD = 0.45, 95% CI = -0.03 to 0.93, P = 0.07; follow-up = 2.4 months). Significant improvement of memory (SMD = 0.33, 95% CI = 0.11-0.55, P < 0.01; follow-up = 4.1 months) and attention/psychomotor speed (SMD = 0.21, 95% CI = 0.04-0.39, P = 0.02; follow-up = 4 months) was also detected. No statistically significant effect on executive function (TMT A/CTT A and TMT B/CTT B; SMD = 0.08, 95% CI = -0.10 to 0.26, P = 0.39; follow-up = 3.9 months and SMD = -0.02, 95% CI = -0.20 to 0.16, P = 0.82, respectively; follow-up = 3.9 months), language ability (BNT; SMD = 0.24, 95% CI = -0.05 to 0.54, P = 0.10; follow-up = 4 months), and functional ability (SMD = -0.05, 95% CI = -0.25 to 0.15, P = 0.63; follow-up = 3.8 months) was observed. No significant effects of the examined covariates were demonstrated in the meta-regression analyses. CONCLUSIONS CAS may be associated with improvement in global cognition, memory, and attention/psychomotor speed. There was no positive effect on executive function, language, and functional ability, but CAS was not associated with a decline in any area of cognitive function. Future studies in larger groups of patients are probably needed to fully investigate the long-term effect of CAS on cognition in patients with carotid artery stenosis.
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Affiliation(s)
- Constantine N Antonopoulos
- Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
| | - John D Kakisis
- Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece
| | - George S Sfyroeras
- Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece
| | - Konstantinos G Moulakakis
- Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece
| | - Aristides Kallinis
- Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece
| | - Triantafillos Giannakopoulos
- Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece
| | - Christos D Liapis
- Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece
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Akkaya E, Vuruskan E, Gul ZB, Yildirim A, Pusuroglu H, Surgit O, Kalkan AK, Akgul O, Akgul GP, Gul M. Cerebral microemboli and neurocognitive change after carotid artery stenting with different embolic protection devices. Int J Cardiol 2014; 176:478-83. [PMID: 25125014 DOI: 10.1016/j.ijcard.2014.07.241] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 07/28/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Proximal cerebral protection devices have been developed as an alternative to filter protection devices for reducing neurological complications during carotid artery stenting (CAS). The aim of the present study was to evaluate the frequency of silent cerebral embolism after CAS using different cerebral embolic protection devices and the impact of silent cerebral embolism on neurocognitive function. METHODS One hundred consecutive patients who underwent CAS were enrolled. The patients were randomized to either proximal balloon occlusion or filter protection. Neurocognitive tests were performed before and six months after CAS. Cerebral embolisms were evaluated with diffusion-weighted magnetic resonance imaging (DW-MRI). RESULTS The number and volume of new ischemic lesions found with DW-MRI were higher in the filter protection group than in the proximal balloon occlusion group. According to our definition, nine (21%) patients in the balloon occlusion group and 16 (36%) patients in the filter protection group showed neurocognitive decline, and ten (23%) patients in the balloon occlusion group and four (9%) patients in the filter protection group showed neurocognitive improvement (NS). Regarding the group of patients with new cerebral ischemic lesions on DW-MRI, neurocognitive decline occurred in 14 (31%) of 45 patients with DW-MRI lesions and 11 (26%) of 43 patients without DW-MRI lesions (NS). CONCLUSION Neurocognitive outcome after CAS is unpredictable; both neurocognitive decline and improvement can occur. In this study, the proximal balloon occlusion system significantly decreased cerebral microemboli during CAS compared to filter protection. Cerebral microembolism was not found to be associated with neurocognitive decline.
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Affiliation(s)
- Emre Akkaya
- Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Ertan Vuruskan
- Department of Cardiology, Gaziantep State Hospital, Gaziantep, Turkey
| | - Zeynep Bastug Gul
- Department of Neurology, Dr. Mazhar Osman Teaching and Research Hospital for Mental Health and Neurological Disorders, Istanbul, Turkey
| | - Aydın Yildirim
- Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hamdi Pusuroglu
- Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Surgit
- Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Kemal Kalkan
- Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Akgul
- Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gamze Pinar Akgul
- Department of Neurology, Gaziantep State Hospital, Gaziantep, Turkey
| | - Mehmet Gul
- Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Stanišić MG, Rzepa T. Reasons underlying the consent to endovascular treatment, displayed by patients diagnosed with asymptomatic internal carotid artery stenosis. Med Sci Monit 2014; 20:1503-9. [PMID: 25150701 PMCID: PMC4156341 DOI: 10.12659/msm.890771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 05/09/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Endovascular treatment of internal carotid artery stenosis (ICAS) has gained popularity in recent years. Offering CAS, which is a controversial treatment in asymptomatic disease, may provoke patient distrust of the diagnosis and intervention benefit. The aim of this study was to prove that asymptomatic ICAS patients tend to show an emotional attitude to their illness, and therefore their decisions regarding carotid artery stenting are externally motivated and assessed emotionally. MATERIAL AND METHODS This study was conducted by a questionnaire consisting of 18 half-open questions (obtained from 25 consecutive patients) in categories of self-image, attitude to illness, and decision-making regarding CAS. Descriptive analysis was performed. RESULTS Reaction: "Nothing to worry about - every illness can be cured" evidenced the rational attitude to the disease. Attitude towards oneself after receiving the unexpected information about the disease did not change. Most patients pursued a second opinion before the intervention. Most patients showed internal motivation (78.7%). Rational assessment of the decision on CAS relied on consulting and insights into the disease and the intervention-related risk compared to risk of "doing nothing" CONCLUSIONS In decision-making about CAS by asymptomatic patients, the emotional attitude to disease and negative expectations pertaining to postoperative health lead to an internally-motivated and rationally assessed decision. At least 2 conversations with the patient should be scheduled. The primary purpose of the second visit should be dissipating any doubts and repeating the arguments for the intervention. Patients should be provided with an appropriate amount of information to reduce their fear of neurological complications and mental disturbances. Conversation should be concentrated on life-quality improvement instead of controversies about the intervention.
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Affiliation(s)
- Michał-Goran Stanišić
- Department of General and Vascular Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Teresa Rzepa
- Institute of Psychology, Warsaw School of Social Sciences and Humanities, Poznań, Poland
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Yan Y, Liang L, Yuan Y, Chen T, Shen Y, Zhong C. Influence of stent-assisted angioplasty on cognitive function and affective disorder in elderly patients with symptomatic vertebrobasilar artery stenosis. Med Sci Monit 2014; 20:1129-36. [PMID: 24990175 PMCID: PMC4095702 DOI: 10.12659/msm.890592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We aimed to investigate cognitive function and affective disorder in elderly patients with symptomatic vertebrobasilar artery stenosis (SVAS) after stent-assisted angioplasty (SAA) and to explore the potential mechanism. MATERIAL AND METHODS The study subjects were 26 elderly SVAS patients who were non-responsive to pharmacotherapy and received SAA (study group) and 30 patients receiving intracoronary stent implantation (control group). Montreal cognitive assessment (MoCA), Hamilton depression rating scale (HAMD), and Hamilton anxiety rating scale (HAMA) were used. RESULTS The total MoCA score, scores of line connection, copying cube, drawing clock, and delayed recall increased significantly in the study group after surgery (P<0.05, P<0.01). In addition, the MoCA score increased over time and the total MoCA score at 12 months was markedly higher than that at 1 month (P<0.05). The scores of HAMD and HAMA decreased dramatically after surgery compared with before surgery in these patients (P<0.01). A comparison at the corresponding period was performed between study group and control group, and it was found that the differences in total MoCA scores and scores of line connection, copying cube, drawing clock, and delayed recall before surgery and at 1 month after surgery were significant (P<0.05, P<0.01). CONCLUSIONS SAA may improve the visuospatial/executive abilities and delayed recall, as well as the depression and anxiety in patients with SVAS. Larger and controlled trails are needed to investigate the effect of SAA on cognition and affection in these patients.
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Affiliation(s)
- Yongxing Yan
- Department of Neurology, Third People's Hospital, Hangzhou, China (mainland)
| | - Lizhen Liang
- Department of Neurology, Third People's Hospital, Hangzhou, China (mainland)
| | - Yanrong Yuan
- Department of Neurology, Third People's Hospital, Hangzhou, China (mainland)
| | - Tao Chen
- Department of Neurology, Third People's Hospital, Hangzhou, China (mainland)
| | - Yonghui Shen
- Department of Neurology, Third People's Hospital, Hangzhou, China (mainland)
| | - Changyang Zhong
- Department of Neurology, Third People's Hospital, Hangzhou, China (mainland)
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Longitudinal Evaluation of Neurobehavioral Outcomes After Carotid Revascularization. Ann Vasc Surg 2014; 28:874-81. [DOI: 10.1016/j.avsg.2013.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/25/2013] [Accepted: 06/16/2013] [Indexed: 11/21/2022]
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Wang L, Li X, Song J, Jiang T, Wu X, Zhou S. Comparisons of cognitive function and serum S-100B level between diabetic and non-diabetic patients after the implantation of carotid artery stent (CAS). Neurosci Lett 2014; 570:58-62. [PMID: 24746932 DOI: 10.1016/j.neulet.2014.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/22/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
To investigate cognitive function improvement in diabetic and non-diabetic patients after the implantation of Carotid Artery Stent (CAS), 128 patients suffering severe carotid stenosis were successfully enrolled in this study. Tests including, the Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog), Clock Drawing Test (CDT), Hasegawa's Dementia Scale-Revised (HDS-R) and the serum levels of S-100B, were all measured at baseline for 3 months after the implantation of CAS. The baseline characteristics were similar between the patients with and without diabetes. 3 months after the implantation, significant improvements in MMSE (24.8 ± 2.2 vs. 25.2 ± 2.1, p=0.003), MoCA (25.6 ± 2.0 vs. 26.1 ± 1.9, p=0.000), ADAS-Cog (6.5 ± 1.3 vs. 6.1 ± 1.3, p=0.000), and CDT (3.3 ± 0.7 vs. 3.5 ± 0.7, p=0.034) were observed in the non-diabetic group. In contrast, there was no significant improvement in any of the cognitive test for the diabetic group. Another interesting discovery was the CAS procedure significantly decreased the S-100B level in the non-diabetic group (0.11 ± 0.04 ng/mL vs. 0.10 ± 0.04 ng/mL, p=0.000), but similar phenomena were not discovered in the diabetic group. In this light, the change of the S-100B level was negatively correlated with the results in the MMSE (p<0.01) and the MoCA (p<0.01) tests, and positively correlated with the result in ADAS-Cog (p<0.05) test. Our findings suggest that the CAS-induced beneficial effects on cognitive function might have a correlation relationship with the serum level of S-100B.
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Affiliation(s)
- Lizhou Wang
- Department of Radiology, Affiliated Hospital of Guiyang Medical College, Guiyang 550004, China
| | - Xing Li
- Department of Radiology, Affiliated Hospital of Guiyang Medical College, Guiyang 550004, China
| | - Jie Song
- Department of Radiology, Affiliated Hospital of Guiyang Medical College, Guiyang 550004, China
| | - Tianpeng Jiang
- Department of Radiology, Affiliated Hospital of Guiyang Medical College, Guiyang 550004, China
| | - Xiaoping Wu
- Department of Radiology, Affiliated Hospital of Guiyang Medical College, Guiyang 550004, China
| | - Shi Zhou
- Department of Radiology, Affiliated Hospital of Guiyang Medical College, Guiyang 550004, China.
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Plessers M, Van Herzeele I, Vermassen F, Vingerhoets G. Neurocognitive functioning after carotid revascularization: a systematic review. Cerebrovasc Dis Extra 2014; 4:132-48. [PMID: 25076958 PMCID: PMC4105952 DOI: 10.1159/000362921] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/15/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The objective of this study was to review the recent literature regarding the neurocognitive consequences of carotid endarterectomy (CEA) and carotid stenting (CAS). METHODS AND RESULTS A PubMed and Web of Science search was conducted using the key words 'carotid' in combination with 'cognitive', 'cognition', 'neurocognition', 'neurocognitive', 'neuropsychology', and 'neuropsychological'. Bibliographies of relevant articles were cross-referenced. We included 37 studies published since 2007 of which 18 examined CEA, 12 CAS, and 7 compared CEA to CAS. There is a wide variability in the reported neurocognitive outcome following CEA and CAS. Nonetheless, none of the included studies unveiled significant differences between CEA and CAS on postoperative neurocognitive functioning. Postoperative changes observed for CEA and CAS separately seem limited to a small percentage (around 10-15%) of patients and can either present as an improvement or impairment. KEY MESSAGES The available data seem to suggest that no obvious cognitive differences between CAS and CEA can be observed after intervention. Both improvement and deterioration in cognitive functioning can be observed following CAS or CEA. Methodological differences such as patient heterogeneity, implementation and type of control groups, type of psychometric tests used, statistical analyses, or timing of the assessments play an important role in explaining the sometimes divergent results of the included studies. Large-scale and methodologically solid studies comparing CEA and CAS on neurocognitive outcome remain warranted. Future studies should implement adequate control groups to correct for practice effects in the target groups.
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Affiliation(s)
- Maarten Plessers
- Department of Experimental Psychology, Ghent University, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Guy Vingerhoets
- Department of Experimental Psychology, Ghent University, Ghent, Belgium
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Chang XL, Zhou HQ, Lei CY, Wu B, Chen YC, Hao ZL, Dong W, Liu M. Association between asymptomatic carotid stenosis and cognitive function: A systematic review. Neurosci Biobehav Rev 2013; 37:1493-9. [DOI: 10.1016/j.neubiorev.2013.05.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/29/2013] [Accepted: 05/23/2013] [Indexed: 11/29/2022]
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He ZJ, Qin B, Cui Z, Liu F, Qi P, Lu J, Liu JC, Wang LJ, Zeng P, Wang DM. Improvement of working memory after stenting for cervicocerebral artery stenosis. J Neurointerv Surg 2013; 6:384-8. [PMID: 23761480 DOI: 10.1136/neurintsurg-2013-010698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the working memory of patients with cervicocerebral artery stenosis and its change after stenting. METHODS 35 patients with cervicocerebral artery stenosis (≥50% with related symptoms of cerebral ischemia, or ≥70% with or without related symptoms of cerebral ischemia) underwent endovascular stenting. Working memory of all 35 patients before and within 3 weeks of stenting was evaluated by memory quotient (MQ) scores. Change in regional cerebral blood flow (rCBF) was assessed by single photon emission CT (SPECT) for 13 of the patients. MQ scores were compared according to location and degree of stenosis for all patients, as well as changes in rCBF for the 13 patients. RESULTS Mean MQ scores were significantly lower than normal for patients with carotid artery stenosis alone and for patients with carotid stenosis in addition to vertebrobasilar and/or subclavical stenosis, but not for patients with vertebrobasilar and/or subclavical stenosis. MQ scores were significantly increased after stenting for all patients, especially those with carotid stenosis. There was no significant difference between patients with moderate stenosis and those with severe (>70%) stenosis in MQ increments pre- and post-stenting (p=0.085). Nine of the 13 patients who received SPECT showed an improvement in rCBF after stenting, and their MQ increments were significantly higher than those without an improvement in rCBF (p=0.020). CONCLUSIONS Working memory impairment can be observed in patients with cervicocerebral artery stenosis, especially those with carotid stenosis. Endovascular stenting of stenosis might improve the impairment by alleviating cerebral perfusion deficit.
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Affiliation(s)
- Zi-Jun He
- Department of Neurosurgery, Beijing Hospital, Beijing, China
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18
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Advanced asymptomatic carotid disease and cognitive impairment: an understated link? Stroke Res Treat 2012; 2012:981416. [PMID: 22577604 PMCID: PMC3329676 DOI: 10.1155/2012/981416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 12/22/2011] [Indexed: 11/24/2022] Open
Abstract
Advanced carotid disease is known to be associated with symptomatic cerebrovascular diseases, such as stroke or transient ischemic attack (TIA), as well as with poststroke cognitive impairment. However, cognitive decline often occurs in patients with advanced carotid stenosis without clinically evident stroke or TIA, so it is also suspected to be an independent risk factor for dementia. Neurosonological methods enable simple and noninvasive assessment of carotid stenosis in patients at risk of advanced atherosclerosis. Cognitive status in patients diagnosed with advanced carotid stenosis is routinely not taken into consideration, although if cognitive impairment is present, such patients should probably be called symptomatic. In this paper, we discuss results of some most important studies that investigated cognitive status of patients with asymptomatic advanced carotid disease and possible mechanisms involved in the causal relationship between asymptomatic advanced carotid disease and cognitive decline.
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Yang B, Chen W, Yang Y, Lin Y, Duan Y, Li J, Wang H, Fu F, Zhuge Q, Chen X. Short- and long-term hemodynamic and clinical effects of carotid artery stenting. AJNR Am J Neuroradiol 2012; 33:1170-6. [PMID: 22268082 DOI: 10.3174/ajnr.a2930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Stenosis of the carotid artery may cause reduced hemodynamic and neural function that may be ameliorated with CAS. The goal of this study was to evaluate short- and long-term hemodynamic and clinical effects after CAS. MATERIALS AND METHODS Hemodynamic parameters were acquired by PCT within 1 week before CAS and at 1 week and 1 year (10-13 months) after CAS. In ACA territory, MCA territory, PCA territory, basal ganglia, anterior and posterior CWS and IWS, the rCBF, rCBV, and rMTT were determined in 20 patients with unilateral carotid artery stenosis who underwent CAS. MR and noncontrast CT were performed within 1 week before CAS. Noncontrast CT and carotid arteriography were performed immediately after CAS. Carotid arteriography was performed 1 year after CAS. MRS was performed in 3 measurements. The variance analysis was performed to determine whether there were significant differences among the 3 measurements. RESULTS No significant differences were found among rCBV in any territory (P > .05). In the non-PCA territories, rMTT decreased and rCBF increased at 1 week after CAS (P < .01), but there was no significant difference between 1-week and 1-year effects (P > .05). For MR spectroscopy, no significant differences were found between 1 week after CAS and pretreatment (P > .05); the 1-year scores improved significantly (P < .01). CONCLUSIONS The long-term hemodynamic and clinical results after treatment validated that CAS is a durable procedure. The 1-week hemodynamic effects can predict long-term effects.
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Affiliation(s)
- B Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical College, WenzhouCity, ZheJiang Province, China
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Mendiz OA, Sposato LA, Fabbro N, Lev GA, Calle A, Valdivieso LR, Fava CM, Klein FR, Torralva T, Gleichgerrcht E, Manes F. Improvement in executive function after unilateral carotid artery stenting for severe asymptomatic stenosis. J Neurosurg 2012; 116:179-84. [DOI: 10.3171/2011.9.jns11532] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Executive functions are crucial for organizing and integrating cognitive processes. While some studies have assessed the effect of carotid artery stenting (CAS) on cognitive functioning, results have been conflicting. The object of this study was to assess the effect of CAS on cognitive status, with special interest on executive functions, among patients with severe asymptomatic internal carotid artery (ICA) stenosis.
Methods
The authors prospectively assessed the neuropsychological status of 20 patients with unilateral asymptomatic extracranial ICA stenosis of 60% or more by using a comprehensive assessment battery focused on executive functions before and after CAS. Individual raw scores on neuropsychological tests were converted into z scores by normalizing for age, sex, and years of education. The authors compared baseline and 3-month postoperative neuropsychological scores by using Wilcoxon signed-rank tests.
Results
The mean preoperative cognitive performance was within normal ranges on all variables. All patients underwent a successful CAS procedure. Executive function scores improved after CAS, relative to baseline performance as follows: set shifting (Trail-Making Test Part B: −0.75 ± 1.43 vs −1.2 ± 1.48, p = 0.003) and processing speed (digit symbol coding: −0.66 ± 0.85 vs −0.97 ± 0.82, p = 0.035; and symbol search: −0.24 ± 1.32 vs −0.56 ± 0.77, p = 0.049). The benefit of CAS for working memory was marginally significant (digit span backward: −0.41 ± 0.61 vs −0.58 ± 0.76, p = 0.052). Both verbal (immediate Rey Auditory Verbal Learning Test: 0.35 ± 1.04 vs −0.22 ± 0.82, p = 0.011) and visual (delayed Rey-Osterrieth Complex Figure: 0.27 ± 1.26 vs −0.22 ± 1.01, p = 0.024) memory improved after CAS.
Conclusions
The authors found a beneficial effect on executive function and memory 3 months after CAS among their prospective cohort of consecutive patients with unilateral and asymptomatic ICA stenosis of 60% or more.
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Affiliation(s)
| | - Luciano A. Sposato
- 2INECO and INECO Foundation, Buenos Aires, Argentina; and
- 3Institute of Neurosciences, Favaloro University Hospital
- 4Laboratory of Neuroscience, Universidad Diego Portales, Santiago, Chile
| | - Nicolás Fabbro
- 3Institute of Neurosciences, Favaloro University Hospital
| | | | - Analía Calle
- 3Institute of Neurosciences, Favaloro University Hospital
| | | | | | | | - Teresa Torralva
- 2INECO and INECO Foundation, Buenos Aires, Argentina; and
- 3Institute of Neurosciences, Favaloro University Hospital
| | - Ezequiel Gleichgerrcht
- 2INECO and INECO Foundation, Buenos Aires, Argentina; and
- 3Institute of Neurosciences, Favaloro University Hospital
| | - Facundo Manes
- 2INECO and INECO Foundation, Buenos Aires, Argentina; and
- 3Institute of Neurosciences, Favaloro University Hospital
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Goldberg JB, Goodney PP, Kumbhani SR, Roth RM, Powell RJ, Likosky DS. Brain Injury After Carotid Revascularization: Outcomes, Mechanisms, and Opportunities for Improvement. Ann Vasc Surg 2011; 25:270-86. [DOI: 10.1016/j.avsg.2010.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 06/01/2010] [Accepted: 07/19/2010] [Indexed: 11/27/2022]
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Chuang YM, Huang KL, Chang YJ, Chang CH, Chang TY, Wu TC, Wong HF, Liu SJ, Lee TH. Immediate Regression of Leukoaraiosis after Carotid Artery Revascularization. Cerebrovasc Dis 2011; 32:439-46. [DOI: 10.1159/000330638] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/14/2011] [Indexed: 11/19/2022] Open
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Tavares A, Caldas JG, Castro CC, Puglia P, Frudit ME, Barbosa LA. Changes in perfusion-weighted magnetic resonance imaging after carotid angioplasty with stent. Interv Neuroradiol 2010; 16:161-9. [PMID: 20642890 DOI: 10.1177/159101991001600207] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 03/28/2010] [Indexed: 11/16/2022] Open
Abstract
Carotid artery stenosis due to arteriosclerosis increases the risk of cerebral ischemia via embolic phenomena or reduced blood flow. The changes in cerebral perfusion that may occur after treatment are not clearly understood. This study evaluated the changes in cerebral microcirculation following carotid angioplasty with stenting (CAS) under cerebral protection with filters using ultrafast gradient echo (GRE) perfusion weighted imaging (PWI) with magnetic resonance imaging (MRI). Prospectively, 21 cervical carotid stenosis patients, mean age 69.95 years, underwent MRI 12 h before and 72 h after CAS. PWI parameters were collected for statistical analysis: cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP). Statistical analysis was applied to absolute parameters and to values normalized against those from the contralateral parenchyma. The main finding of this study was improved hemodynamics for the normalized data after CAS, shown by reduced MTT (p<0.001) and TTP (p=0.019) in the territory fed by the middle cerebral artery ipsilateral to the CAS. Absolute data showed increased blood volume in the cerebral hemispheres after CAS, which was more accentuated on the stent side (p=0.016) than the contralateral side (p=0.029). Early improvements in cerebral perfusion, mainly seen in the normalized data, were clearly demonstrated in the timing parameters - TTP & MTT - after CAS.
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Affiliation(s)
- A Tavares
- Universidade de São Paulo, São Paulo, Brazil.
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Raabe RD, Burr RB, Short R. One-year Cognitive Outcomes Associated with Carotid Artery Stent Placement. J Vasc Interv Radiol 2010; 21:983-8; quiz 989. [DOI: 10.1016/j.jvir.2010.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 03/09/2010] [Accepted: 03/12/2010] [Indexed: 10/19/2022] Open
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Takaiwa A, Hayashi N, Kuwayama N, Akioka N, Kubo M, Endo S. Changes in cognitive function during the 1-year period following endarterectomy and stenting of patients with high-grade carotid artery stenosis. Acta Neurochir (Wien) 2009; 151:1593-600. [PMID: 19533017 DOI: 10.1007/s00701-009-0420-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 05/18/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND In patients with severe carotid artery stenosis, cognitive decline and changes in cognitive function before to after treatment have been noted, though the true effects of treatment in such patients remain unclear. A convenient and repeatable neuropsychological test battery is needed for such patients. METHODS In 26 patients with severe carotid artery stenosis treated by carotid endarterectomy (CEA) and stenting (CAS), cognitive function was examined before and 1 week, 3 months, 6 months, and 1 year after treatment. RBANS and MMSE were selected as a test battery, and changes in test scores and long-term results of revascularization were evaluated. RESULTS RBANS was useful and suitable for neuropsychological testing in such patients, and yielded the following results: (1) Patients before treatment had, on average, RBANS scores rated low average, with mild but relatively diffuse cognitive impairment; (2) RBANS scores were increased significantly at 3 months after CEA and CAS, and cognitive improvement was maintained over 1 year; and (3) scores were decreased temporarily at 1 week after CEA, but not after CAS. CONCLUSIONS Patients with severe carotid artery stenosis exhibited mild decline in cognitive function, which was improved after CEA and CAS. RBANS is a suitable test battery for this type of patient.
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de la Torre JC. Carotid artery ultrasound and echocardiography testing to lower the prevalence of Alzheimer's disease. J Stroke Cerebrovasc Dis 2009; 18:319-28. [PMID: 19560690 DOI: 10.1016/j.jstrokecerebrovasdis.2008.11.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 10/29/2008] [Accepted: 11/03/2008] [Indexed: 12/22/2022] Open
Abstract
The use of two clinic office techniques, carotid artery ultrasound and echocardiography (CAUSE), to detect deficient brain blood flow delivery in the healthy, cognitively normal, older individual is proposed. Evidence indicates that persistent heart-to-brain blood flow deficit involving low cardiac output or low ejection fraction and carotid artery narrowing can promote cognitive impairment and that such impairment may lead to Alzheimer's disease (AD) or vascular dementia (VaD). A number of independent epidemiologic studies reported cardiovascular and cerebrovascular disease to be risk factors to AD and VaD. The clinical rationale for CAUSE is to detect and prevent progression of cognitive dysfunction in elderly persons and is based on the general understanding that mild cognitive impairment is a preclinical threshold to AD or VaD with high conversion rates to either dementia. The use of CAUSE is anticipated to prevent or attenuate, by appropriate clinical management, mild cognitive impairment arising from persistent brain hypoperfusion, a condition implicated in the promotion of cognitive impairment in the elderly and a common preclinical feature seen in AD and VaD. As detection of lowered cerebral perfusion from cardiac and carotid artery pathology is achieved using these cost-effective, noninvasive, and relatively accurate ultrasound procedures, a significant reduction in the number of new AD and VaD cases would be anticipated after appropriate patient treatment. In this context, a brief summary is presented outlining recent medical and surgical treatments that may improve cerebral blood flow insufficiency. The merit of CAUSE in screening and treating mentally healthy elderly persons who are identified as being at risk of cognitive decline is that it could blunt the soaring socioeconomic impact that will hammer the health care system of many nations by the mounting dementia prevalence rate expected in the next 25 years. A 5- year delay in the onset of AD could reduce the prevalence of AD by 50%. We are making preparations to test the merit of CAUSE in a clinical study of a cognitively healthy elderly population.
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Affiliation(s)
- Jack C de la Torre
- Center for Alzheimer's Research, Sun Health Research Institute, Sun City, Arizona 85351, USA.
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Tiemann L, Reidt JH, Esposito L, Sander D, Theiss W, Poppert H. Neuropsychological sequelae of carotid angioplasty with stent placement: correlation with ischemic lesions in diffusion weighted imaging. PLoS One 2009; 4:e7001. [PMID: 19746158 PMCID: PMC2734991 DOI: 10.1371/journal.pone.0007001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 07/24/2009] [Indexed: 12/02/2022] Open
Abstract
Background and Purpose Few studies investigated the neuropsychological outcome after carotid angioplasty with stent placement (CAS), yielding partially inconsistent results. The present investigation evaluated the effect of CAS in patients with high-grade stenosis and assessed the predictive value of ischemic lesion number for postinterventional cognitive deterioration. Methods 22 patients were tested neuropsychologically before and six weeks after CAS. Cerebral ischemic changes were assessed with diffusion weighted imaging (DWI) prior to and after angioplasty. Results Pre- to postinterventional cognitive performance improved significantly in terms of verbal memory (t = −2.30; p<0.05), whereas significant deterioration was noted regarding verbal memory span (t = 2.31; p<0.05). 8 (36%) persons conformed to the criteria of cognitive improvement. 6 patients (27%) were postinterventionally classified as having deficits. Analysis yielded no statistically significant correlations between lesion quantity and cognitive change. Conclusion Both improvement and deterioration of cognitive functioning was observed in our collective of patients, leaving the neuropsychological outcome after percutaneous transluminal angioplasty unpredictable in individual cases. The presence of acute ischemic lesions on DWI was found to be not tightly associated with cognitive dysfunction after CAS.
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Affiliation(s)
- Laura Tiemann
- Neurologische Klinik und Poliklinik der Technischen Universität München, Munich, Germany.
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Sztriha LK, Nemeth D, Sefcsik T, Vecsei L. Carotid stenosis and the cognitive function. J Neurol Sci 2009; 283:36-40. [PMID: 19269651 DOI: 10.1016/j.jns.2009.02.307] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
In 2008 we witnessed a rapid advancement in stent technology, which is reflected in the high number of case reports, publications of case series, and randomized trials. Stents not only served for a combined intrasaccular and extrasaccular treatment of challenging aneurysms but also assisted the revascularization in acute and chronic ischemic conditions of the neurovascular system. Although a self-expanding nitinol semiopen cell stent is currently used for intracranial occlusive disease, a new retrievable closed-cell designed stent is widely used for aneurysms because of its easy delivery through a microcatheter in frequently tortuous head and neck as well as cerebrovascular circulation (
Figure 1
). However, despite numerous publications in the field, the widespread acceptance of the use of stents to routinely treat carotid stenosis awaits the results of the multicenter randomized clinical trials that should be available in 2009. The role of interventional neuroradiology in the treatment of acute ischemic stroke continues to expand and excite interest.
Figure 1.
Intracranial nitinol self-expanding stents used for endovascular treatment of aneurysm in conjunction with coil embolization. A, Closed cell design with flaring ends (Enterprise VRD; Codman Neurovascular, Raynham, MA). B, Semiopen cell design (Neuroform; Boston Scientific, Natick, MA).
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Affiliation(s)
- Ajay K. Wakhloo
- From Department of Radiology (A.K.W., M.J.D.), University of Massachusetts, Worcester, Mass; Institute of Neurology (M.M.B.), National Hospital, London, UK
| | - Michael J. Deleo
- From Department of Radiology (A.K.W., M.J.D.), University of Massachusetts, Worcester, Mass; Institute of Neurology (M.M.B.), National Hospital, London, UK
| | - Martin M. Brown
- From Department of Radiology (A.K.W., M.J.D.), University of Massachusetts, Worcester, Mass; Institute of Neurology (M.M.B.), National Hospital, London, UK
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Iancu A, Lazar A. Re: "midterm results of a sirolimus-eluting stent implanted for recurrent carotid in-stent restenosis". J Endovasc Ther 2008; 15:706-7. [PMID: 19090635 DOI: 10.1583/08-2575.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Although dementia is a clinical diagnosis, neuroimaging often is crucial for proper assessment. Magnetic resonance imaging (MRI) and computed tomography (CT) may identify nondegenerative and potentially treatable causes of dementia. Recent neuroimaging advances, such as the Pittsburgh Compound-B (PIB) ligand for positron emission tomography imaging in Alzheimer's disease, will improve our ability to differentiate among the neurodegenerative dementias. High-resolution volumetric MRI has increased the capacity to identify the various forms of the frontotemporal lobar degeneration spectrum and some forms of parkinsonism or cerebellar neurodegenerative disorders, such as corticobasal degeneration, progressive supranuclear palsy, multiple system atrophy, and spinocerebellar ataxias. In many cases, the specific pattern of cortical and subcortical abnormalities on MRI has diagnostic utility. Finally, among the new MRI methods, diffusion-weighted MRI can help in the early diagnosis of Creutzfeldt-Jakob disease. Although only clinical assessment can lead to a diagnosis of dementia, neuroimaging is clearly an invaluable tool for the clinician in the differential diagnosis.
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Affiliation(s)
- Paolo Vitali
- Department of Neurology, UCSF Memory and Aging Center, University of California-San Francisco, CA 94143, USA
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