Abstract
OBJECTIVES Carotid interventions have been shown to decrease stroke risk and improve cerebral perfusion. However, nearly 40% of patients who undergo carotid revascularization procedures experience cognitive deterioration. We have demonstrated that subclinical microembolization is associated with memory decline, but whether genetic factors plays a role in post-procedural cognitive change is unclear. We herein seek to assess genetic determinants as potential risk factors for these procedures. METHODS Over one year period, patients undergoing carotid interventions at a single academic institution were recruited to participate. Patients underwent neuropsychological testing two weeks prior to and at one month following their procedure and MRI prior to and within 48 hours following their procedure. Saliva samples were collected for genetic testing and demographics were recorded. Logistic regressions were used to search for associations. RESULTS 34 patients were included (18 CAS, 16 CEA); all were male with a mean age of 68. The majority of patients exhibit hypertension (94%) and have a history of smoking (76%). Other co-morbidities included diabetes (47%), obesity (35%), and CAD (44%). Consistent with previous findings, CAS was associated with higher incidence of microemboli (p=.0005) and with susceptibility to memory decline (p=.0085). Negative univariate associations were found for 5-HTT (serotonin transporter) short alleles with memory decline (p=.016) and brain-derived neurotrophic factor (BDNF) polymorphism with incidence of microemboli (p=.018). After adjusting for apolipoprotein E (ApoE) risk alleles, incidence of microemboli trended with memory decline (p=.099). CONCLUSIONS Despite a small number of patients, our study showed that genetic polymorphisms such as 5-HTT, BDNF, and ApoE may provide additional insight on post-operative changes in cognition. Further investigation of these polymorphisms is warranted to understand and potentially prevent cognitive deterioration following carotid revascularization procedures.
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