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OBJECTIVE: Carotid interventions are important in helping to reduce the risk of stroke for patients with high-grade carotid artery stenosis; however, incidence of subclinical cerebral microemboli can occur during these procedures. Previously, associations have been found between incidence of microemboli and postoperative decline in memory. We therefore sought to determine whether this decline persisted long-term and to look at changes in other cognitive domains.
METHODS: Patients were prospectively recruited under an IRB-approved protocol at a single academic center. Neuropsychological testing was administered preoperatively and at 1 month and 6 month intervals postoperatively. Cognitive domains that were evaluated included verbal memory, visual memory, psychomotor speed, dexterity, and executive function. DW-MRI sequencing was performed preoperatively and within 48 hours postoperatively to identify new microemboli. Univariate and multivariate regression models were used to identify relationships between microembolization, demographics, and cognition.
RESULTS: 80 patients were included; all were male and average age was 69. 40 underwent CAS and 40 CEA. 45% were diabetic, 50% had CAD, and 41% had prior neurologic symptoms. 45 (56%) of the patients had new postoperative microemboli. Microembolization was significantly more common in the CAS cohort (p<.01). Using multivariate regressions, cognitive decline at 1 month postoperatively was associated with microemboli for the verbal memory short delay measure (p=.052), Trails A psychomotor speed task (p=.008), and grooved peg dexterity test (p=.043). However, at 6 months following intervention performance on these tasks returned to baseline levels. Multivariate regression also revealed that decline in dexterity was associated with contralateral occlusion at 1 month (p=.001) and persisted at 6 months (p=.002) following intervention.
CONCLUSIONS: Microembolization that is associated with carotid artery intervention may result in short-term cognitive decline. These deficits largely resolve within 6 months following intervention, however further investigation is warranted to determine individual patient risk factors that may impact recovery.