Abstract T P91: Reversion of Cognitive Impairment by Carotid Revascularization in Asymptomatic Carotid Stenosis? A Nonrandomized Controlled Study

Abstract

We previously reported that patients with asymptomatic severe stenosis of extracranial internal carotid artery (ICA) have worse dizziness and poorer cognitive performance than matched controls in association with distributed and long-range brain disconnections. There is currently a lack of evidence whether optimal medical treatment alone or with carotid revascularization could be the best treatment for cognitive impairment in these patients. We consecutively followed 25 patients with asymptomatic severe stenosis (>70%) of ICA. Sixteen received carotid artery stenting (CAS) and optimal medical treatment and nine received optimal medical treatment alone. All subjects received a battery of neuropsychological tests as well as diffusion tensor imaging and resting-state functional magnetic resonance imaging, and were followed at three months after treatments. We found that patients receiving CAS (100% success), but not those receiving medical treatment alone, had significant improvements in dizziness scores (P=0.001), immediate recall of verbal memory (P=0.002) and complex visuospatial perception (P=0.007) three month after intervention. The interval changes of whole-brain mean fractional anisotropy of both groups were insignificant, and the analysis of functional connectivity is undergoing. The results may provide insight into whether the benefits of carotid revascularization, including mitigating thromboembolic events and cognitive impairment, outweigh perioperative risks including functional consequence of microemboli.