Internal Carotid Artery Stenting: Predictive Screening of Cognitive Function

• Published in: Human physiology Vol. 46; no. 8; pp. 817 - 822
• Main Authors: Medvedev, R. B., Gemdzhian, E. G., Shchipakin, V. L., Koshcheev, A. Yu, Konovalov, R. N., Tanashyan, M. M.
• Format: Journal Article
• Language: English
• Published: Moscow Pleiades Publishing 01-12-2020; Springer Nature B.V
• Subjects: Angioplasty; Aphasia; Arteriosclerosis; Asymptomatic; Biomedical and Life Sciences; Biomedicine; Carotid arteries; Carotid artery; Cognitive ability; Human Physiology; Life Sciences; Magnetic resonance imaging; Mental disorders; Neuroimaging; Neurological diseases; Patients; Restenosis; Statins; Statistical analysis; Stenosis; Stents; Stroke; Surgery; Ultrasound; cognitive function; carotid artery; stenosis; stenting
• ISSN: 0362-1197; 1608-3164
• DOI: 10.1134/S0362119720080101

Carotid artery stenting is a common method of stroke prevention. The aim of this work was to examine the relationship between carotid angioplasty with stenting (CAS) of the internal carotid artery (ICA) and cognitive function (CF), based on two years of patient follow-up data (after stenting), including clinical assessment and neuroimaging using magnetic resonance imaging (MRI). This prospective study included 137 patients (64% men) aged 47 to 85 years (with a median age of 66 years), who had undergone CAS for atherosclerotic stenosis. The inclusion criterion was stenosis (symptomatic or asymptomatic) of the internal carotid artery, which was confirmed on ultrasound. The exclusion criteria were patients with stroke (whose neurological deficits included aphasia and/or neglect), severe cognitive and mental disorders, contraindications to antiplatelet drugs and statins, and patients with ICA restenosis after prior carotid endarterectomy. The Montreal Cognitive Assessment (MoCA) Test was used for cognitive function screening before stenting, and 6, 12, and 24 months after the vascular intervention. Diffusion-weighted MRI was used to assess the presence (before CAS and 24 hours after surgery) of focal cerebral changes, specifically intraoperative acute embolic lesions (AEL). Patients with previously identified AEL were re-examined using 3D-FLAIR MRI after 6 months. The number of patients with cognitive impairment, who had scored less than 26 points on the MoCA, was 23/137 (17%) prior to the CAS. When measured 6, 12 and 24 months after stenting, there was no statistically or clinically significant change in cognitive function in 125/137 (91%) patients, cognitive function improved in 12/137 (9%) (3 of whom had reduced CF before stenting), and there were no instances of deterioration. No association was found between asymptomatic foci due to intraoperative AEL, and postoperative cognitive abilities.