OBJECTIVE: Approximately 25% of patients with carotid artery stenosis treated with carotid endarterectomy develop cognitive dysfunction (CD) between 1 day and 1 month after surgery compared with a control group. We hypothesized that patients with carotid artery stenosis treated with carotid artery stenting (CAS) performed under cerebral embolic protection also develop CD at similar time points compared with a control group. METHODS: Twenty-four patients scheduled for elective CAS were enrolled in a prospective institutional review board-approved study to evaluate cognitive function with a battery of 6 neuropsychometric tests before, and 1 day and 1 month after, CAS. Test performance was compared with 23 patients undergoing coronary artery procedures (control group). The mean and standard deviation of the difference scores in the control group were used to generate Z scores. We used a previously described point system to transform negative Z scores into injury points for each neuropsychometric test. Global performance is presented as average deficit score (sum of injury points divided by the number of completed tests). All patients underwent the procedures with mild sedation. Results were analyzed in 2 ways: group-rate and event-rate analysis. Outcome was dichotomized by defining moderate to severe CD as average deficit score at least 1.5 standard deviations worse than the control group. Fisher tests and multivariate logistic regression models were used to analyze group performance. RESULTS: Control patients tended to be younger and had a lower incidence of stroke or previous transient ischemic attack. One day after surgery, 41% of patients (10 of 24) treated with CAS developed moderate to severe CD (P = 0.0422). Average deficit score was also significantly higher in the CAS group at 1 day (P = 0.0265). These differences were independent of age and history of stroke/transient ischemic attack. Interestingly, we found that the absence of oral statin medication may increase the probability of CD. By 1 month, 9% of patients (1 of 11) treated with CAS presented with CD. Other patients were lost to follow-up. CONCLUSION: CAS is associated with a decline in cognitive performance that is at least moderate 1 day after surgery.
OBJECTIVE: Approximately 25% of patients with carotid artery stenosis treated with carotid endarterectomy develop cognitive dysfunction (CD) between 1 day and 1 month after surgery compared with a control group. We hypothesized that patients with carotid artery stenosis treated with carotid artery stenting (CAS) performed under cerebral embolic protection also develop CD at similar time points compared with a control group. METHODS: Twenty-four patients scheduled for elective CAS were enrolled in a prospective institutional review board-approved study to evaluate cognitive function with a battery of 6 neuropsychometric tests before, and 1 day and 1 month after, CAS. Test performance was compared with 23 patients undergoing coronary artery procedures (control group). The mean and standard deviation of the difference scores in the control group were used to generate Z scores. We used a previously described point system to transform negative Z scores into injury points for each neuropsychometric test. Global performance is presented as average deficit score (sum of injury points divided by the number of completed tests). All patients underwent the procedures with mild sedation. Results were analyzed in 2 ways: group-rate and event-rate analysis. Outcome was dichotomized by defining moderate to severe CD as average deficit score at least 1.5 standard deviations worse than the control group. Fisher tests and multivariate logistic regression models were used to analyze group performance. RESULTS: Control patients tended to be younger and had a lower incidence of stroke or previous transient ischemic attack. One day after surgery, 41% of patients (10 of 24) treated with CAS developed moderate to severe CD (P = 0.0422). Average deficit score was also significantly higher in the CAS group at 1 day (P = 0.0265). These differences were independent of age and history of stroke/transient ischemic attack. Interestingly, we found that the absence of oral statin medication may increase the probability of CD. By 1 month, 9% of patients (1 of 11) treated with CAS presented with CD. Other patients were lost to follow-up. CONCLUSION:CAS is associated with a decline in cognitive performance that is at least moderate 1 day after surgery.
Authors: Walther N K A van Mook; Roger J M W Rennenberg; Geert Willem Schurink; Robert Jan van Oostenbrugge; Werner H Mess; Paul A M Hofman; Peter W de Leeuw Journal: Lancet Neurol Date: 2005-12 Impact factor: 44.182
Authors: Eric J Heyer; Ruchey Sharma; Anita Rampersad; Christopher J Winfree; William J Mack; Robert A Solomon; George J Todd; Paul C McCormick; James G McMurtry; Donald O Quest; Yaakov Stern; Ronald M Lazar; E Sander Connolly Journal: Arch Neurol Date: 2002-02
Authors: J Lehrner; A Willfort; I Mlekusch; G Guttmann; E Minar; R Ahmadi; W Lalouschek; L Deecke; W Lang Journal: J Clin Exp Neuropsychol Date: 2005-10 Impact factor: 2.475
Authors: Eric J Heyer; Joanna L Mergeche; Samuel S Bruce; Justin T Ward; Yaakov Stern; Zirka H Anastasian; Donald O Quest; Robert A Solomon; George J Todd; Alan I Benvenisty; James F McKinsey; Roman Nowygrod; Nicholas J Morrissey; E Sander Connolly Journal: Stroke Date: 2013-02-12 Impact factor: 7.914
Authors: Eric J Heyer; Christopher P Kellner; Hani R Malone; Samuel S Bruce; Joanna L Mergeche; Justin T Ward; E Sander Connolly Journal: J Neurosurg Date: 2013-05-10 Impact factor: 5.115
Authors: Eric J Heyer; Joanna L Mergeche; Yaakov Stern; Hani R Malone; Samuel S Bruce; Justin T Ward; E Sander Connolly Journal: J Clin Neurosci Date: 2013-10-16 Impact factor: 1.961
Authors: Zhang Yong Xia; Qin Jian Sun; Hua Yang; Ming Xia Zhang; Ru Ban; Ge Lin Xu; Ya Ping Wu; Le Xin Wang; Yi Feng Du Journal: PLoS One Date: 2015-06-11 Impact factor: 3.240
Authors: Barbora Urbanova; Ales Tomek; Robert Mikulik; Hana Magerova; Daniel Horinek; Jakub Hort Journal: Front Behav Neurosci Date: 2014-01-21 Impact factor: 3.558