Carotid Stenosis and Cognitive Function: An Update on Therapeutic Interventions.

Carotid stenosis (CS) is closely associated with cognitive decline, primarily affecting memory, attention, and executive function. This relationship is explained by mechanisms such as chronic cerebral hypoperfusion and asymptomatic microembolism. Interventions like carotid endarterectomy (CEA) and carotid artery stenting (CAS) have demonstrated potential benefits in restoring cerebral perfusion; however, outcomes are variable, particularly in domains such as executive function. These differences may be attributed to patient characteristics, the degree of stenosis, and the technique employed. Revascularization is more commonly associated with the stabilization of cognitive decline rather than the active improvement of cognitive function. CEA has shown superiority over CAS in promoting recovery of cerebral connectivity and hemodynamic stability. Improvements have been documented using instruments such as the Montreal Cognitive Assessment (MoCA), especially in patients with baseline cognitive impairment. Complications such as postoperative cognitive dysfunction (POCD) and hyperperfusion syndrome underscore the importance of appropriate patient selection, taking into account factors such as advanced age, hypertension, and bilateral stenosis. Biomarkers such as the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios are associated with a higher risk of postoperative cognitive deterioration. Imaging modalities, including functional magnetic resonance imaging, support evidence of functional recovery following CEA. Questions remain regarding the long-term benefits, optimal selection criteria, and predictive value of biomarkers, all of which represent key areas for future research.