Abstract 3393: The Effect Of Carotid Revascularization On Patients With Baseline Cognitive Impairment

Abstract

Objectives: The effect of carotid revascularization on cognitive function is controversial. The goal of this study was to assess the degree of cognitive improvement following carotid revascularization in patients with baseline cognitive impairment. Methods: Patients with carotid stenosis >60% were enrolled prospectively from 3 sites from 2005 to 2010. Patients underwent either carotid endarterectomy or carotid artery stenting. Neuropsychological testing was administered pre-operatively, 1 month, 6 months, and 1 year post-operatively. Cognitive assessments included Trails A (attention), Trails B (executive functioning), and Hopkins Verbal Learning Test (HVLT-R) (new learning/memory). A baseline cognitive impairment was defined as a score ≤ 10 th percentile of age-adjusted normative data. Results: Of 61 eligible patients, 49 (80%) completed testing at 6-months and/or 1-year post-operatively. Mean age was 73.1 years, 56% were male, and 30% were symptomatic. Pre-operative Trails A impairment was observed in 16% of patients, Trails B in 27%, and a component of HVLT-R in 41%. Following revascularization, patients with a baseline cognitive impairment demonstrated an average improvement of 28.6% and 22.8% in Trails A and B, compared to 4.3% (p=0.04) and 9.2% (p=0.06) in patients with normal baseline cognitive function ( Figure 1 ). Similarly, impaired patients exhibited average improvements of 36.5% in HVLT-Total Recall, 38.5% in Delayed Recall, and 36.7% in Retention, compared to 11.0% (p=0.004), 6.1% (p=0.004), and 0.97% (p=0.002), respectively, in patients with normal cognitive function ( Figure 1 ). Conclusion: Baseline cognitive impairment in attention, executive functioning, and new learning/memory appear to be significant variables in predicting which patients experience the greatest cognitive benefits following carotid revascularization.