Abstract
Background and ObjectivesCarotid artery stenting (CAS) is an important therapeutic strategy for patients with carotid artery stenosis. However, the potential influence of CAS on cognitive function in patients with carotid artery stenosis and cerebral lacunar infarction has not been determined. This study investigated changes in cognitive function associated with CAS and the factors related to these changes.MethodsThis prospective cohort study comprised 579 Chinese patients with cerebral lacunar infarction and carotid artery stenosis for whom CAS was indicated, and a matched control group of 552 healthy individuals. Cognitive function before CAS and at scheduled intervals from 6 months to 3 years was assessed with instruments that included the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scale. Potential factors that might affect cognitive function were analyzed via logistic regression.ResultsThe MMSE and MoCA scores of the patients before CAS were significantly lower than that of the control subjects. These scores were significantly higher 6 months after CAS and sustained or increased throughout the 3-year follow-up. Also significantly improved after CAS from baseline were scores for an alternating trail test, cube copying, clock-drawing, attention, and delayed recall in an auditory-verbal learning test. Logistic regression analyses showed that age greater than 65 y, little education, diabetes, and hypertension were independent risk factors for deteriorated MoCA scores 3 years after CAS.ConclusionCAS was associated with significantly improved cognitive function in cerebral lacunar infarction patients with severe stenosis.
Highlights
The morbidity and mortality of stroke remains high in both developed [1] and developing countries [2], despite advances in diagnostic and therapeutic strategies
Carotid artery stenting (CAS) was associated with significantly improved cognitive function in cerebral lacunar infarction patients with severe stenosis
The results indicated that the cognition of patients with severe stenosis of the internal carotid artery (ICA) and Cerebral lacunar infarction (CLI) at baseline was significantly impaired compared with the controls
Summary
The morbidity and mortality of stroke remains high in both developed [1] and developing countries [2], despite advances in diagnostic and therapeutic strategies. Cerebral lacunar infarction (CLI), a small deep infarction of the brain due mainly to an occlusion of a penetrating artery, accounts for about a quarter of all ischemic strokes [3]. Recent studies have suggested that patients with CLI are at increased risk of cognitive disorders and dementia [6]. Strategies for early prevention of deterioration of cognitive function in CLI patients are urgently needed. Carotid artery stenting (CAS) is an important therapeutic strategy for patients with carotid artery stenosis. The potential influence of CAS on cognitive function in patients with carotid artery stenosis and cerebral lacunar infarction has not been determined. This study investigated changes in cognitive function associated with CAS and the factors related to these changes
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