Impaired cognitive function is often reported in patients with carotid artery stenosis. Revascularization by transcervical carotid artery stenting (CAS) with flow reversal is associated with increased cognition regardless of age, asymtomatic status, previous stroke events, baseline brain parenchyma status, and contralateral carotid artery stenosis. The findings of this preliminary prospective study suggest that transcervical CAS and stenting with flow reversal for cerebral protection is a safe technique that will improve, or at least not worsen, cognitive performance.

Keywords:
Carotid stenting, Cognition, Neuropsychological improvement
1.
Bakker FC, Klijn CJM, Jennekens-Schinkel A, Kappelle LJ: Cognitive disorders in patients with occlusive disease of the carotid artery: a systemic review of the literature. J Neurol 2000;247:669–676.
2.
Feliziani FT, Polidori MC, De Rango P, Mangialasche F, Monastero R, Ercolani S, Raichi T, Cornacchiola V, Nelles G, Cao P, Mecocci P: Cognitive performance in elderly patients undergoing carotid endarterectomy or carotid artery stenting: a twelve-month follow-up study. Cerebrovasc Dis 2010;30:244–251.
3.
Xu G, Liu X, Meyer JS, Yin Q, Zhang R: Cognitive performance after carotid angioplasty and stenting with brain protection devices. Neurol Res 2007;29:251–255.
4.
Borroni B, Tiberio G, Bonardelli S, Cottini E, Facheris M, Akkawi N, et al: Is mild vascular cognitive impairment reversible? Evidence from a study on the effect of carotid endarterectomy. Neurol Res 2004;26:594–597.
5.
Kishikawa K, Kamouchi M, Okada Y, Inoue T, Ibayashi S, Iida MJ: Effects of carotid endarterectomy on cerebral blood flow and neuropsychological test performance in patients with high-grade carotid stenosis. Neurol Sci 2003;213:19–24.
6.
Lehrner J, Willfort A, Mlekusch I, Guttmann G, Minar E, Ahmadi R, et al: Neuropsychological outcome 6 months after unilateral carotid stenting. J Clin Exp Neuropsychol 2005;27:859–866.
7.
Pearson S, Maddern G, Fitridge R: Cognitive performance in patients after carotid endarterectomy. J Vasc Surg 2003;38:1248–1252, discussion 1252–1253.
8.
Mlekusch W, Mlekusch I, Haumer M, Kopp CW, Lehrner J, Ahmadi R, et al: Improvement of neurocognitive function after protected carotid artery stenting. Catheter Cardiovasc Interv 2008;71:114–119.
9.
Zhou W, Dinishak D, Lane B, Hernandez-Boussard T, Bech F, Rosen A: Long-term radiographic outcomes of microemboli following carotid interventions. J Vasc Surg 2009;50:1314–1319.
10.
Altinbas A, van Zandvoort MJ, van den Berg E, Jongen LM, Algra A, Moll FL, Nederkoorn PJ, Mali WP, Bonati LH, Brown MM, Kappelle LJ, van der Worp HB: Cognition after carotid endarterectomy or stenting: a randomized comparison. Neurology 2011;77:1084–1090.
11.
Crawley F, Stygall J, Lunn S, Harrison M, Brown MM, Newman S: Comparison of microembolism detected by transcranial Doppler and neuropsychological sequelae of carotid surgery and percutaneous transluminal angioplasty. Stroke 2000;31:1329–1334.
12.
Schnaudigel S, Gröschel K, Pilgram SM, Kastrup A: New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 2008;39:1911–1919.
13.
Bonati LH, Jongen LM, Haller S, Flach HZ, Dobson J, Nederkoorn PJ, MacDonald S, Gaines PA, Waaijer A, Stierli P, Jäger HR, Lyrer PA, Kappelle LJ, Wetzel SG, van der Lugt A, Mali WP, Brown MM, van der Worp HB, Engelter ST, ICSS-MRI Study Group: New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 2010;9:353–362. Erratum in: Lancet Neurol 2010;9:345.
14.
Lopez OL, Jagust WJ, Dulberg C, Becker JT, DeKosky ST, Fitzpatrick A, Breitner J, Lyketsos C, Jones B, Kawas C, Carlson M, Kuller LH: Risk factors for mild cognitive impairment in the Cardiovascular Health Study Cognition Study. Part 2. Arch Neurol 2003;60:1394–1399.
15.
Ribo M, Molina CA, Alvarez B, Rubiera M, Alvarez-Sabin J, Matas M: Transcranial Doppler monitoring of transcervical carotid stenting with flow reversal protection: a novel carotid revascularization technique. Stroke 2006;37:2846–2849.
16.
Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, et al: Protected carotid-artery stenting versus endarterectomy in high-risk patients. Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators. N Engl J Med 2004;51:1493–1501.
17.
Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjögren M, et al: A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke 2001;32:1318–1322.
18.
Criado E, Doblas M, Fontcuberta J, Orgaz A, Flores A: Transcervical carotid artery angioplasty and stenting with carotid flow reversal: surgical technique. Ann Vasc Surg 2004;18:257–261.
19.
Matas M, Alvarez B, Ribo M: Transcervical carotid stenting with flow reversal protection: experience in high-risk patients. J Vasc Surg 2007;46:49–54.
20.
Rango P, Caso V, Leys D, Paciaroni M, Lenti M, Cao P: The role of carotid artery stenting and carotid endarterectomy in cognitive performance: a systematic review. Stroke 2008;39:3116–3127.
21.
Korczyn AD, Vakhapova V: The prevention of the dementia epidemic. J Neurol Sci 2007;257:2–4.
22.
Johnston SC, O’Meara ES, Manolio TA, Lefkowitz D, O’Leary DH, Goldstein S, Carlson MC, Fried LP, Longstreth WT Jr: Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease. Ann Intern Med 2004;140:237–247.
23.
Alvarez B, Ribo M, Maeso J, Quintana M, Alvarez-Sabin J, Matas M: Transcervical carotid stenting with flow reversal is safe in octogenarians: a preliminary safety study. J Vasc Surg 2008;47:96–100.
© 2013 S. Karger AG, Basel
2013
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