The effect of unilateral carotid endarterectomy on neuropsychological test performance in 53 patients.

Six psychomotor tests (Ravens matrices, finger tapping, spatial orientation, arithmetic, vocabulary, and short-term memory) were administered preoperatively, at 3-7 days and 3 months postoperatively to 53 patients undergoing unilateral carotid endarterectomy between 1978 and 1982. Standard operative technique included general anesthesia and Javid shunt. None of the patients experienced postoperative neurological deficit or significant complications. Individual and cumulative test scores were correlated with prior CVA, neurological examination, cerebral angiography, pre and postoperative computerized cerebral tomograms and intraoperative carotid flow measurements. Psychometric scores did not change postoperatively in 18 patients with prior CVA's. Forty-five patients operated upon for high grade stenosis (75% reduction in cross sectional diameter) had a significant increase in early post-endarterectomy test scores which returned to preoperative levels by three months postoperatively. Increase in intra-operative carotid artery blood flow correlated with improved test performance. We conclude that carotid endarterectomy of flow restrictive stenosis initially augments psychometric test performance but the improvement is not sustained at the third postoperative month.