Prospective comparison of cognitive effects of carotid endarterectomy versus carotid stenting with flow reversal or distal filters.

OBJECTIVE

It is unclear whether carotid revascularization can improve the cognitive problems often observed in patients with carotid stenosis. We examined the presence of preoperative disturbances and the effects of different types of carotid revascularization on cognition.

METHOD

Forty-six patients treated for significant carotid stenosis [26 carotid endarterectomy (CEA), 10 transfemoral carotid stenting with distal filters (CASdp), and 10 transcervical stenting with flow reversal (CASfr)] as well as a matched control group of 26 vascular patients without carotid stenosis were included. Patients and controls were tested 1 day preoperatively and 1, 6, and 12 months after surgery on 18 neuropsychological variables.

RESULTS

A significant amount of carotid patients as well as vascular controls showed cognitive defects at preoperative testing. None of the neuropsychological variables showed significant group differences between CEA, CASdp, CASfr, and controls, and only 1 revealed interaction between type of revascularization and improvements over time, though this effect dissolved when 2 outliers were excluded. Thirteen of 18 variables showed improved scores over time, regardless of the group. Compared with controls, about 10% of patients showed improvements, while 20% showed cognitive deterioration 6 months after revascularization.

CONCLUSIONS

Results show similar effects for CEA, CASdp, and CASfr on cognition. Large practice effects due to repeated testing confirm the importance of using control groups in prospective cognition studies. Because of the small sample size, this study should be regarded as an exploratory study; larger studies on the cognitive consequences of carotid revascularization remain warranted.