PHILADELPHIA — Both carotid artery stenting and carotid endarterectomy produced a roughly 50% increase in overall cognitive function in a study of 46 patients undergoing intervention for asymptomatic severe carotid stenosis.
The change was big enough to significantly improve the patients' quality of life. But both revascularization methods also had a price: Carotid stenting resulted in a clinically significant deterioration in average psychomotor speed, and carotid endarterectomy produced a clinically significant decrease in average memory.
The unexpected finding raised questions about how two methods of carotid revascularization produce two different sets of cognitive outcomes.
“We were very surprised by the results,” Dr. Brajesh K. Lal said at the annual meeting of the Eastern Vascular Society.
“There is a lot to understand about the travel of microparticles, which may selectively affect different parts of the brain.” That is just one possible explanation for the finding. Stenting and endarterectomy differ in arterial clamping, balloon placement, stenting, dissection, and hypoperfusion, any of which could play a role. “We hypothesize multiple mechanisms by which carotid endarterectomy and stenting produce cognitive dysfunction,” said Dr. Lal, a vascular surgeon at the University of Maryland, Baltimore.
The study administered six cognitive tests to 46 asymptomatic patients with unilateral carotid stenosis of 70% or more who were scheduled to undergo revascularization. Patients took 50 minutes to complete the panel of tests before surgery and again at 4-6 months after treatment. After treatment, the composite score rose by an average of 0.47 for the stented patients, compared with baseline, and by 0.51 for the endarterectomy patients. The cognitive changes, scored on a scale of 0-1.0, showed that the two groups weren't significantly different, but the increases in both groups were very clinically meaningful.
The same panel of tests should be used on similar patients managed medically to gauge the cognitive effect of medical treatment, Dr. Lal said.
The findings raise questions about how two methods of carotid revascularization produce different outcomes.
Source DR. LAL
Elsevier Global Medical News