Cognition after carotid endarterectomy or stenting: A randomized comparison

A. Altinbas*, M. J. E. van Zandvoort, E. van den Berg, L. M. Jongen, A. Algra, F. L. Moll, P. J. Nederkoorn, W. P. T. M. Mali, L. H. Bonati, M. M. Brown, L. J. Kappelle, H. B. van der Worp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

84 Citations (Scopus)

Abstract

Objective: To compare the effect on cognition of carotid artery stenting (CAS) and carotid endarterectomy (CEA) for symptomatic carotid artery stenosis.

Methods: Patients randomized to CAS or CEA in the International Carotid Stenting Study (ICSS; ISRCTN25337470) at 2 participating centers underwent detailed neuropsychological examinations (NPE) before and 6 months after revascularization. Ischemic brain lesions were assessed with diffusion-weighted imaging before and within 3 days after revascularization. Cognitive test results were standardized into z scores, from which a cognitive sumscore was calculated. The primary outcome was the change in cognitive sumscore between baseline and follow-up.

Results: Of the 1,713 patients included in ICSS, 177 were enrolled in the 2 centers during the substudy period, of whom 140 had an NPE at baseline and 120 at follow-up. One patient with an unreliable baseline NPE was excluded. CAS was associated with a larger decrease in cognition than CEA, but the between-group difference was not statistically significant: -0.17 (95% CI -0.38 to 0.03; p = 0.092). Eighty-nine patients had a pretreatment MRI and 64 within 3 days after revascularization. New ischemic lesions were found twice as often after CAS than after CEA (relative risk 2.1; 95% CI 1.0 to 4.4; p = 0.041).

Conclusions: Differences between CAS and CEA in effect on cognition were not statistically significant, despite a substantially higher rate of new ischemic lesions after CAS than after CEA. Classification of Evidence: This study provides Class III evidence that any difference between the effects of CAS and CEA on cognition at 6 months after revascularization is small. Neurology (R) 2011; 77: 1084-1090

Original languageEnglish
Pages (from-to)1084-1090
Number of pages7
JournalNeurology
Volume77
Issue number11
Early online date31 Aug 2011
DOIs
Publication statusPublished - Sept 2011

Bibliographical note

Supported by the Netherlands Heart Foundation (2005B027 to B.v.d.W.). ICSS was funded by the Medical Research Council (and managed by NIHR on behalf of the MRC-NIHR partnership), the Stroke Association, Sanofi-Synthélabo, and the European Union. L.H.B. was supported by grants from the Swiss National Science Foundation (PBBSB-116873) and the University of Basel. M.M.B.'s Chair in Stroke Medicine is supported by the Reta Lila Weston Trust for Medical Research. This work was partly done at University College London Hospital and University College London, which received a proportion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding schemes.

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