Effect of Carotid Artery Stenting and Extracranial-Intracranial By-Pass on Cognitive Function: Preliminary Results
Affiliation(s)
1 Department of Radiology, Tianjin Huan Hu Hospital, Tianjin, China. 2 Department of Neurology, Tianjin Huan Hu Hospital, Tianjin, China.
1 Department of Radiology, Tianjin Huan Hu Hospital, Tianjin, China. 2 Department of Neurology, Tianjin Huan Hu Hospital, Tianjin, China.
ABSTRACT
Background: To compare the neuropsychological consequences after carotid artery stenting (CAS) and extracranial-intracranial by-pass (EC-IC by-pass). Methods: A total of 43 patients referred to CAS, 32 patients referred to EC-IC by-pass and 43 control subjects were enrolled in the study. Neuropsychologic testing was performed before and three months after procedure. A paired Student t test was used to compare neuropsychologic test scores at baseline and three months after procedure in each group. Cognitive changes in a three-month follow-up were not normally distributed and compared among/between groups with Kruskal-Wallis test. Results: Three months after the treatment both the CAS and EC-IC by-pass groups showed improved cognitive performance compared to baseline, whereas the same improvement wasn’t seen in the control group. The scores from Activities of Daily Living also improved in all three groups in a three-month follow-up, and EC-IC group presented a more distinct increase in daily life abilities comparing to the other two groups. Conclusions: CAS and EC-IC by-pass in patients with a carotid or intracranial stenosis may result in cognitive improvement three months after surgery.
Cite this paper
Liu, L. and Zhou, Y. (2015) Effect of Carotid Artery Stenting and Extracranial-Intracranial By-Pass on Cognitive Function: Preliminary Results. International Journal of Clinical Medicine, 6, 377-383. doi: 10.4236/ijcm.2015.66049.
Liu, L. and Zhou, Y. (2015) Effect of Carotid Artery Stenting and Extracranial-Intracranial By-Pass on Cognitive Function: Preliminary Results. International Journal of Clinical Medicine, 6, 377-383. doi: 10.4236/ijcm.2015.66049.
References
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http://dx.doi.org/10.3171/2011.9.JNS11532 [20] Grunwald, I.Q., Supprian, T., Politi, M., Struffert, T., Falkai, P., Krick, C., et al. (2006) Cognitive Changes after Carotid Artery Stenting. Neuroradiology, 48, 319-323.
http://dx.doi.org/10.1007/s00234-006-0064-5 [21] Xu, G.L., Liu, X.F., Meyer, J.S., Yin, Q. and Zhang, R. (2007) Cognitive Performance after Carotid Angioplasty and Stenting with Brain Protection Devices. Neurological Research, 29, 251-255.
http://dx.doi.org/10.1179/016164107X159216 [22] Kostopanagiotou, G., Markantonis, S.L., Polydorou, M., Pandazi, A. and Kottis, G. (2005) Recovery and Cognitive Function after Fentanyl or Remifentanil Administration for Carotid Endarterectomy. Journal of Clinical Anesthesia, 17, 16-20.
http://dx.doi.org/10.1016/j.jclinane.2004.03.008 [23] Kastrup, A., Groschel, K., Krapf, H., Brehm, B.R., Dichgans, J. and Schulz, J.B. (2003) Early Outcome of Carotid Angioplasty and Stenting with and without Cerebral Protection Devices: A Systematic Review of the Literature. Stroke, 34, 813-819.
http://dx.doi.org/10.1161/01.STR.0000058160.53040.5F [24] Eskandari, M.K. (2005) Cerebral Embolic Protection. Seminars in Vascular Surgery, 18, 95-100.
http://dx.doi.org/10.1053/j.semvascsurg.2005.04.006 [25] Yoshimoto, Y. and Kwak, S. (1995) Superficial Temporal Artery—Middle Cerebral Artery Anastomosis for Acute Cerebral Ischemia: The Effect of Small Augmentation of Blood Flow. Acta Neurochirurgica, 137, 128-137.
http://dx.doi.org/10.1007/BF02187184 [26] Pikus, H.J. and Heros, R.C. (1999) Stroke: Indications for Emergent Surgical Intervention. Clinical Neurosurgery, 45, 113-127. [27] EC-IC Bypass Study Group (1985) Failure of Extracranial-Intracranial Arterial Bypass to Reduce the Risk of Ischemic Stroke: Results of an International Randomized Trial. New England Journal of Medicine, 313, 1191-1200.
http://dx.doi.org/10.1056/NEJM198511073131904
[1] Barnett, H.J., Taylor, D.W., Eliasziw, M., et al. (1998) Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. The New England Journal of Medicine, 339, 1415-1425.
http://dx.doi.org/10.1056/NEJM199811123392002 [2] Mathiesen, E.B., Waterloo, K., Joakimsen, O., et al. (2004) Reduced Neuropsychological Test Performance in Asymptomatic Carotid Stenosis: The Tromso Study. Neurology, 62, 695-701.
http://dx.doi.org/10.1212/01.WNL.0000113759.80877.1F [3] Romero, J.R., Beiser, A., Seshadri, S., et al. (2009) Carotid Artery Atherosclerosis, MRI Indices of Brain Ischemia, Aging, and Cognitive Impairment: The Framingham Study. Stroke, 40, 1590-1596.
http://dx.doi.org/10.1161/STROKEAHA.108.535245 [4] De la Torre, J.C. (2004) Is Alzheimer’s Disease a Neurodegenerative or a Vascular Disorder? Data, Dogma, and Dialectics. Lancet Neurology, 3, 184-190.
http://dx.doi.org/10.1016/S1474-4422(04)00683-0 [5] Norris, E.J. (2010) Anesthesia for Vascular Surgery. In: Miller, R.D., Ed., Miller’s Anesthesia, Churchill Livingstone Elsevier, Philadelphia.
http://dx.doi.org/10.1016/B978-0-443-06959-8.00062-5 [6] Derdeyn, C.P. (2007) Mechanisms of Ischemic Stroke Secondary to Large Artery Atherosclerotic Disease. Neuroimaging Clinics of North America, 17, 303-311.
http://dx.doi.org/10.1016/j.nic.2007.03.001 [7] Zlokovic, B.V. (2005) Neurovascular Mechanisms of Alzheimer’s Neurodegeneration. Trends in Neurosciences, 28, 202-208.
http://dx.doi.org/10.1016/j.tins.2005.02.001 [8] Nishio, K., Ihara, M., Yamasaki, N., et al. (2010) A Mouse Model Characterizing Features of Vascular Dementia with Hippocampal Atrophy. Stroke, 41, 1278-1284.
http://dx.doi.org/10.1161/STROKEAHA.110.581686 [9] Lin, M.S., Chiu, M.J., Wu, Y.W., et al. (2011) Neurocognitive Improvement after Carotid Artery Stenting in Patients with Chronic Internal Carotid Artery Occlusion and Cerebral Ischemia. Stroke, 42, 2850-2854.
http://dx.doi.org/10.1161/STROKEAHA.111.613133 [10] Lal, B.K., Younes, M., Cruz, G., et al. (2011) Cognitive Changes after Surgery vs Stenting for Carotid Artery Stenosis. Journal of Vascular Surgery, 54, 691-698.
http://dx.doi.org/10.1016/j.jvs.2011.03.253 [11] Grunwald, I.Q., Papanagiotou, P., Reith, W., Backens, M., Supprian, T., Politi, M., et al. (2010) Influence of Carotid Artery Stenting on Cognitive Function. Neuroradiology, 52, 61-66.
http://dx.doi.org/10.1007/s00234-009-0618-4 [12] Dong, Y.H., Teoh, H.L., Chan, B.P.L., Ning, C., Yeo, T.T., Sinha, A.K., et al. (2012) Changes in Cerebral Hemodynamic and Cognitive Parameters after External Carotid-Internal Carotid Bypass Surgery in Patients with Severe Steno-Occlusive Disease: A Pilot Study. Journal of the Neurological Sciences, 322, 112-116.
http://dx.doi.org/10.1016/j.jns.2012.07.034 [13] Bendszus, M. and Stoll, G. (2006) Silent Cerebral Ischaemia: Hidden Fingerprints of Invasive Medical Procedures. The Lancet Neurology, 5, 364-572.
http://dx.doi.org/10.1016/S1474-4422(06)70412-4 [14] Brott, T.G., Hobson II, R.W., Howard, G., Roubin, G.S., Clark, W.M., Brooks, W., et al. (2010) Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis. New England Journal of Medicine, 363, 11-23.
http://dx.doi.org/10.1056/NEJMoa0912321 [15] Hassoun, H.T., Malas, M.B. and Freischlag, J.A. (2010) Secondary Stroke Prevention in the Era of Carotid Stenting: Update on Recent Trials. Archives of Surgery, 145, 928-935.
http://dx.doi.org/10.1001/archsurg.2010.204 [16] Gaudet, J.G., Meyers, P.M. and McKinsey, J.F. (2009) Incidence of Moderate to Severe Cognitive Dysfunction in Patients Treated with Carotid Artery Stenting. Neurosurgery, 65, 325-330.
http://dx.doi.org/10.1227/01.NEU.0000349920.69637.78 [17] De Rango, P., Caso, V., Leys, D., Paciaroni, M., Lenti, M. and Cao, P. (2008) The Role of Carotid Artery Stenting and Carotid Endarterectomy in Cognitive Performance: A Systematic Review. Stroke, 39, 3116-3127.
http://dx.doi.org/10.1161/STROKEAHA.108.518357 [18] Turk, A.S., Chaudry, I., Haughton, V.M., Hermann, B.P., Rowley, H.A., Pulfer, K., et al. (2008) Effect of Carotid Artery Stenting on Cognitive Function in Patients with Carotid Artery Stenosis: Preliminary Results. American Journal of Neuroradiology, 29, 265-268.
http://dx.doi.org/10.3174/ajnr.A0828 [19] Mendiz, O.A., Sposato, L.A., Fabbro, N., Lev, G.A., Calle, A., Valdivieso, L.R., et al. (2012) Improvement in Executive Function after Unilateral Carotid Artery Stenting for Severe Asymptomatic Stenosis. Journal of Neurosurgery, 116, 179-184.
http://dx.doi.org/10.3171/2011.9.JNS11532 [20] Grunwald, I.Q., Supprian, T., Politi, M., Struffert, T., Falkai, P., Krick, C., et al. (2006) Cognitive Changes after Carotid Artery Stenting. Neuroradiology, 48, 319-323.
http://dx.doi.org/10.1007/s00234-006-0064-5 [21] Xu, G.L., Liu, X.F., Meyer, J.S., Yin, Q. and Zhang, R. (2007) Cognitive Performance after Carotid Angioplasty and Stenting with Brain Protection Devices. Neurological Research, 29, 251-255.
http://dx.doi.org/10.1179/016164107X159216 [22] Kostopanagiotou, G., Markantonis, S.L., Polydorou, M., Pandazi, A. and Kottis, G. (2005) Recovery and Cognitive Function after Fentanyl or Remifentanil Administration for Carotid Endarterectomy. Journal of Clinical Anesthesia, 17, 16-20.
http://dx.doi.org/10.1016/j.jclinane.2004.03.008 [23] Kastrup, A., Groschel, K., Krapf, H., Brehm, B.R., Dichgans, J. and Schulz, J.B. (2003) Early Outcome of Carotid Angioplasty and Stenting with and without Cerebral Protection Devices: A Systematic Review of the Literature. Stroke, 34, 813-819.
http://dx.doi.org/10.1161/01.STR.0000058160.53040.5F [24] Eskandari, M.K. (2005) Cerebral Embolic Protection. Seminars in Vascular Surgery, 18, 95-100.
http://dx.doi.org/10.1053/j.semvascsurg.2005.04.006 [25] Yoshimoto, Y. and Kwak, S. (1995) Superficial Temporal Artery—Middle Cerebral Artery Anastomosis for Acute Cerebral Ischemia: The Effect of Small Augmentation of Blood Flow. Acta Neurochirurgica, 137, 128-137.
http://dx.doi.org/10.1007/BF02187184 [26] Pikus, H.J. and Heros, R.C. (1999) Stroke: Indications for Emergent Surgical Intervention. Clinical Neurosurgery, 45, 113-127. [27] EC-IC Bypass Study Group (1985) Failure of Extracranial-Intracranial Arterial Bypass to Reduce the Risk of Ischemic Stroke: Results of an International Randomized Trial. New England Journal of Medicine, 313, 1191-1200.
http://dx.doi.org/10.1056/NEJM198511073131904