Carotid stenting improves cognitive function in asymptomatic cerebral ischemia

Objectives: Asymptomatic critical internal carotid artery (ICA) stenosis may lead to cognitive impairment. Carotid stenting (CS) may improve cerebral perfusion, but its impact on neuro-cognitive function has been controversial. Methods: We prospectively enrolled 34 asymptomatic patients with unilateral ICA stenosis or occlusion, in whom CS was attempted. Computed tomography cerebral perfusion (CTP), and functional assessments including National Institutes of Health Stoke Scale (NIHSS), Bathel Index (BI), and a battery of neuropsychological tests including Mini-Mental State Examination (MMSE), Alzheimer Disease Assessment Scale-Cognitive Subtest (ADAS-Cog), verbal fluency, and Color Trail Making A and B, were done prior to and 3 months after the procedure. Results: Successful CS was achieved in 28 of 34 patients (82%). Based on the baseline CTP finding and intervention result, patients were divided into three groups: group I (n = 6) as ipsilateral cerebral ischemia with failed CS procedure, group II (n = 17) as ipsilateral cerebral ischemia with successful CS procedure, and group III (n = 11) as normal baseline CTP with successful CS procedure. The demographics and baseline cognitive performances were similar among the three groups. In group II, there were significant improvement in Alzheimer Disease Assessment Scale (pre 6.8 +/- 4.3 vs post 4.9 +/- 2.8, p = 0.033), Mini-Mental State Examination Score (pre 25.8 +/- 3.8 vs post 27.4 +/- 3.5, p = 0.007), and Color Trail test A (pre 120.4 +/- 73.9 s vs post 95.8 +/- 57.6 s, p = 0.004) after CS. In groups I and III, however, no significant difference was observed in any of the cognitive tests. Conclusions: Successful CS improves neurocognitive function in asymptomatic ICA stenosis or occlusion with objective ipsilateral ischemia. (C) 2011 Elsevier Ireland Ltd. All rights reserved.