Cognitive Effects After Carotid
Intervention: Can Patients Actually Have
Improved Function?
Wei Zhou, MD
Professor and Chief, Division of Vascular Surgery
University of Arizona
Banner University Medical Center
Disclosures
Grant funding
– AHA: CRP
– NIH NINDS
NIH R01: Cognitive effect of microemboli following CAS
NIH R21: Neuroimaging correlates of memory decline following carotid interventions
Cognition
3
- “A Problem for Our Age”
CVH Study: Cognitive
impairment and decline
Worse information-
processing speed,
executive function, and
global cognition
Stroke 2009; 40(5):1590-6
Higher silence
infarcts, larger white
matter hyper-intensity,
poorer executive
function
Carotid Disease and Cognition
Perform worse on
cognitive
measures
Perfusion
6
16.5% had embolic signals at baseline
> 40% of asymptomatic lesions have embolic signal during a follow-up of 4 years
Arch Neurol, 2010
Best medical therapy improves baseline microemboli 12.6%3.7%
Am J Psychiatry 2012
Carotid Revascularization
and Cognition
- Stroke 2011
Memory Changes
MMSE Changes
Carotid Interventions
26%
Improved
Declined
39%
Procedure-related Embolization
Subclinical microembolization
– common (25-70%), 3x more following carotid stenting
than carotid endarterectomy
– Not associated w/neurologic symptoms
Subclinical Embolization
Table I: Neuropsychological tests to evaluate cognitive function
Cognitive domains Tests
Individual Difference/General Screen
IQ estimate WTAR
General Functioning MMSE
Depression GDS (15 item)
Attention/Executive/Speed
Psychomotor speed Digit Symbol subtest (WAIS-III)
Psychomotor speed Trail Making Test (Part A)
Executive Trail Making Test (Part B)
Attention/Working Memory Digit Span subtest (WMS-III)
Attention/Working Memory/Executive
Letter/Number Span (WMS-III)
Motor speed and strength
Grooved Pegboard Task
Memory
Verbal Logical Memory subtest (WMS-III)
Verbal RAVLT
Visual Faces subtest (WMS-III)
Visuospatial Function
Clock Drawing
Language
Executive/language Category Fluency
Confrontation Naming Boston Naming Test (CERAD 15 item)
Regions implicated in executive
control, mental speed, and memory
- Rosen..Zhou et al, Neuroimage: Clinical, 2018
JVS 2012; 56: 1571-8
p = 0.05
No emboliN=35
With EmboliN=45
Δ S
core
Microemboli correlate with memory
(RAVLT) decline at one month postopJVS2016
Decline @ 1 mo,
recovered @ 6 mo
Improvement
Decline
CEA vs. CAS
*
JVS2017
Stroke 2012; 43:2567-
73
Baseline Brain Organization
Decliners
Community1&Component1
Community2
Community3&Component2
Community4&Component3
Non-Decliners
Community1
Community3Community2&Component1
Soman et al, Human Brain Mapping 37: 2185-94
Ann Surgery 2016, 264
Summary
Carotid disease affects cognition
Carotid intervention may have a positive or
negative effect on cognition. Need to
select right therapy for right lesion
