Effect of Carotid Artery Stenting on Cognitive Function in Patients With Carotid Artery Stenosis: Preliminary Results

A.S Turk,R.L Levine,D.B Niemann,K Pulfer,V.M Haughton,H.A Rowley,B.P Hermann,B Aagaard-Kienitz,P.A Turski,I Chaudry,C.M Strother

doi:10.3174/ajnr.a0828

Abstract

Stenosis of the carotid artery may be a cause of reduced cognitive performance that can be ameliorated with placement of a stent. The goal of this study was to measure cognitive performance and speed of psychomotor performance prospectively before and after carotid stent placement. Patients referred for stent placement for a unilateral carotid artery stenosis were enrolled in the study. Neuropsychologic testing was performed with a Mini-Mental State Examination, an extended mental status examination, a subjective cognitive status measure, and a psychomotor performance test for speed. The severity of the stenosis was measured on angiograms performed before stent placement. Three months after stent placement, CT angiograms were performed and the neuropsychologic testing was repeated. Differences in neuropsychologic test scores before and after stent placement were calculated and tested for significance with a Student t test. Seventeen patients with a single unilateral carotid stenosis of more than 50% completed the study. Stenosis of the carotid artery averaged 80% before treatment and 18% after treatment. After stenting, the scores from the extended mental status examination improved significantly. The scores from the subjective cognitive status measure also improved. No significant change was noted in the scores from the Mini-Mental State Examination or in the speed of psychomotor performance. Carotid stent placement in patients with a unilateral stenosis of the carotid artery resulted in significant improvement in cognitive test scores in this highly selected patient group. Further studies are needed to confirm these preliminary observations.

Highlights

AND PURPOSE: Stenosis of the carotid artery may be a cause of reduced cognitive performance that can be ameliorated with placement of a stent
Carotid stent placement in patients with a unilateral stenosis of the carotid artery resulted in significant improvement in cognitive test scores in this highly selected patient group
Evidence is accumulating that revascularization of a carotid stenosis may improve cognitive performance.[7,8,9,10,11,12,13]

Summary

Methods

Patients referred for stent placement for a unilateral carotid artery stenosis were enrolled in the study. We asked patients who were referred to the neuroendovascular service for stent placement of a unilateral carotid stenosis between July 2005 and December 2006 to participate in the study. Initial selection of the patients was performed with CT angiogram (CTA), and conventional cerebral angiograms were performed in anticipation of carotid stent placement. Inclusion criteria included recent (within 30 days of the date of procedure) CTA of the head and neck, evidence of an isolated stenosis of 1 carotid artery of more than 50% confirmed with conventional angiography, age older than[18] years, and selection by the treating vascular disease specialist as a suitable candidate for stent placement. A neuroradiologist and neuroendovascular physician reviewed the CT and CTA studies to determine that the patients met criteria for enrollment

Results

Discussion

Conclusion