Changes in Cognitive Functions after Carotid Endarterectomy and Carotid Stenting: A Decade-Apart Comparison

Daniel Václavík; David Pakizer; Tomáš Hrbáč; Martin Roubec; Václav Procházka; Tomáš Jonszta; Roman Herzig; David Školoudík

doi:10.3390/biomedicines12010013

Changes in Cognitive Functions after Carotid Endarterectomy and Carotid Stenting: A Decade-Apart Comparison

Biomedicines. 2023 Dec 20;12(1):13. doi: 10.3390/biomedicines12010013.

Authors

Daniel Václavík^{1

2

3}, David Pakizer⁴, Tomáš Hrbáč^{5

6}, Martin Roubec^{1

4}, Václav Procházka⁷, Tomáš Jonszta⁷, Roman Herzig², David Školoudík^{1

4}

Affiliations

¹ Department of Neurology, University Hospital Ostrava, 708 00 Ostrava, Czech Republic.
² Comprehensive Stroke Centre, Department of Neurology, Charles University Faculty of Medicine and University Hospital, 500 05 Hradec Králové, Czech Republic.
³ Stroke Centre, Department of Neurology, Hospital Agel Ostrava Vitkovice, 703 00 Ostrava, Czech Republic.
⁴ Centre for Health Research, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.
⁵ Department of Neurosurgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic.
⁶ Department of Neuroscience, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic.
⁷ Department of Radiodiagnostics, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic.

Abstract

Background: This study investigates changes in cognitive function in patients with severe carotid stenosis who underwent carotid endarterectomy (CEA) and carotid stenting (CAS) over two decades.

Methods: We compared cognitive function within 30 days after the procedure in 267 patients (first 100 each for CEA and CAS in two periods: 2008-2012 and 2018-2022) in a single institution. Assessments used Adenbrooke's Cognitive Examination-Revised (ACE-R), the Mini-Mental State Examination (MMSE), Speech Fluency Test (SFT), and Clock Drawing Test (CDT), conducted before and 30 ± 2 days after surgery.

Results: Patients (mean age 67.2 years, 70%+ carotid stenosis) exhibited different cognitive changes over periods. In 2008-2012, significant declines in MMSE (CEA, p = 0.049) and CDT (CAS, p = 0.015) were observed among asymptomatic patients. On the contrary, in 2018-2022, improvements were observed in ACE-R and MMSE for symptomatic and asymptomatic patients undergoing CEA and CAS.

Conclusion: Over a decade, advances in interventional techniques and patient management have reduced risks of cognitive decline in patients with asymptomatic carotid stenosis and also have improved cognitive functions in both symptomatic and asymptomatic individuals.

Keywords: carotid endarterectomy; carotid stenosis.

Grants and funding

D. Pakizer was supported by University of Ostrava (grant No. SGS21/LF/2023). The study was supported by STROCZECH within CZECRIN Large Research Infrastructure (No. LM2023049) funded by the state budget of the Czech Republic. This study was supported by the Ministry of Health of the Czech Republic (grants NV-19-04-00270, NV-19-08-00362, NU22-04-00389). D. Václavík and R. Herzig were supported by the Ministry of Health of the Czech Republic (grant No. DRO—UHHK 00179906) and Charles University, Czech Republic (Cooperatio Program, research area NEUR).