OBJECTIVE: To investigate the effect of protected carotid artery stenting on neurocognitive function with particular consideration of the angiographic filling of the ipsilateral anterior cerebral artery (ACA). BACKGROUND: An improved inflow to the supply area of the anterior cerebral artery after revascularisation of severe carotid artery stenosis may beneficially affect frontal lobe cognitive functions. METHODS: We prospectively included 71 consecutive patients who underwent carotid artery stenting (CAS) due to high grade carotid artery stenosis. Intracranial angiograms and filling status of the ACA pre- and post-stenting were analyzed and a battery of 5 selected neuropsychological tests for frontal lobe function were applied prior to and 6 months after CAS. Patients with improvement in at least two tests were defined as having improved neurocognitive function. RESULTS: Compared to baseline, we found a significant improvement of the Trail-Making Test A (median 6% improved change-score; P = 0.01), the test of supermarket items showed a trend towards significant improvement (median 3.7% improved change-score; P = 0.09). In 32 patients (45%) an improvement of at least 2 neurocognitive tests was observed. Neuropsychological improvement was found more frequently in patients with a contrasted ipsilateral ACA after CAS (88%, 95% CI 77 to 99) compared to patients without angiographic filling of the ipsilateral ACA post CAS (13%, 95% CI 1 to 25), respectively (P < 0.01). CONCLUSION: Carotid artery stenting improves neurocognitive function in a considerable proportion of patients. A contrasted ipsilateral anterior cerebral artery after CAS is associated with improved neurocognitive function, presumably due to amelioration of frontal lobe perfusion. Copyright 2008 Wiley-Liss, Inc.
OBJECTIVE: To investigate the effect of protected carotid artery stenting on neurocognitive function with particular consideration of the angiographic filling of the ipsilateral anterior cerebral artery (ACA). BACKGROUND: An improved inflow to the supply area of the anterior cerebral artery after revascularisation of severe carotid artery stenosis may beneficially affect frontal lobe cognitive functions. METHODS: We prospectively included 71 consecutive patients who underwent carotid artery stenting (CAS) due to high grade carotid artery stenosis. Intracranial angiograms and filling status of the ACA pre- and post-stenting were analyzed and a battery of 5 selected neuropsychological tests for frontal lobe function were applied prior to and 6 months after CAS. Patients with improvement in at least two tests were defined as having improved neurocognitive function. RESULTS: Compared to baseline, we found a significant improvement of the Trail-Making Test A (median 6% improved change-score; P = 0.01), the test of supermarket items showed a trend towards significant improvement (median 3.7% improved change-score; P = 0.09). In 32 patients (45%) an improvement of at least 2 neurocognitive tests was observed. Neuropsychological improvement was found more frequently in patients with a contrasted ipsilateral ACA after CAS (88%, 95% CI 77 to 99) compared to patients without angiographic filling of the ipsilateral ACA post CAS (13%, 95% CI 1 to 25), respectively (P < 0.01). CONCLUSION: Carotid artery stenting improves neurocognitive function in a considerable proportion of patients. A contrasted ipsilateral anterior cerebral artery after CAS is associated with improved neurocognitive function, presumably due to amelioration of frontal lobe perfusion. Copyright 2008 Wiley-Liss, Inc.
Authors: David Zade; Alexa Beiser; Regina McGlinchey; Rhoda Au; Sudha Seshadri; Carole Palumbo; Philip A Wolf; Charles Decarli; William Milberg Journal: J Stroke Cerebrovasc Dis Date: 2010-05-14 Impact factor: 2.136