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Open Access 01-11-2012 | Original Communication

Age-dependent effects of carotid endarterectomy or stenting on cognitive performance

Authors: Katrin Wasser, Helmut Hildebrandt, Sonja Gröschel, Tomislav Stojanovic, Holger Schmidt, Klaus Gröschel, Sara M. Pilgram-Pastor, Michael Knauth, Andreas Kastrup

Published in: Journal of Neurology | Issue 11/2012

Abstract

Although evidence is accumulating that age modifies the risk of carotid angioplasty and stenting (CAS) versus endarterectomy (CEA) for patients with significant carotid stenosis, the impact of age on cognition after either CEA or CAS remains unclear. In this study, we analyzed the effects of age on cognitive performance after either CEA or CAS using a comprehensive neuropsychological test battery with parallel test forms and a control group to exclude a learning effect. The neuropsychological outcomes after revascularization were determined in 19 CAS and 27 CEA patients with severe carotid stenosis. The patients were subdivided according to their median age (<68 years and ≥68 years); 27 healthy subjects served as a control group. In all patients clinical examinations, MRI scans and a neuropsychological test battery that assessed four major cognitive domains were performed immediately before, within 72 h, and 3 months after CEA or CAS. While patients <68 years of age showed no significant cognitive alteration after either CEA or CAS, a significant cognitive decline was observed in patients ≥68 years in both treatment groups (p = 0.001). Notably, this cognitive deterioration persisted in patients after CEA, whereas it was only transient in patients treated with CAS. These results demonstrate an age-dependent effect of CEA and CAS on cognitive functions. In contrast to the recently observed increased clinical complication rates in older subjects after CAS compared with CEA, CEA appears to be associated with a greater, persistent decline in cognitive performance than CAS in this subgroup of patients.

Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, Halperin JL, Johnston SC, Katzan I, Kernan WN, Mitchell PH, Ovbiagele B, Palesch YY, Sacco RL, Schwamm LH, Wassertheil-Smoller S, Turan TN, Wentworth D (2011) Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42:227–276PubMedCrossRef

Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T (2006) Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke 37:577–617PubMedCrossRef

Ackerstaff RG, Moons KG, van de Vlasakker CJ, Moll FL, Vermeulen FE, Algra A, Spencer MP (2000) Association of intraoperative transcranial Doppler monitoring variables with stroke from carotid endarterectomy. Stroke 31:1817–1823PubMedCrossRef

Crawley F, Stygall J, Lunn S, Harrison M, Brown MM, Newman S (2000) Comparison of microembolism detected by transcranial Doppler and neuropsychological sequelae of carotid surgery and percutaneous transluminal angioplasty. Stroke 31:1329–1334PubMedCrossRef

Bonati LH, Jongen LM, Haller S, Flach HZ, Dobson J, Nederkoorn PJ, Macdonald S, Gaines PA, Waaijer A, Stierli P, Jager HR, Lyrer PA, Kappelle LJ, Wetzel SG, van der Lugt A, Mali WP, Brown MM, van der Worp HB, Engelter ST (2010) New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 9:353–362PubMedCrossRef

Schnaudigel S, Gröschel K, Pilgram SM, Kastrup A (2008) New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 39:1911–1919PubMedCrossRef

Bonati LH, Dobson J, Algra A, Branchereau A, Chatellier G, Fraedrich G, Mali WP, Zeumer H, Brown MM, Mas JL, Ringleb PA (2010) Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data. Lancet 376:1062–1073PubMedCrossRef

Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23PubMedCrossRef

Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, de Borst GJ, Lo TH, Gaines P, Dorman PJ, Macdonald S, Lyrer PA, Hendriks JM, McCollum C, Nederkoorn PJ, Brown MM (2010) Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 375:985–997PubMedCrossRef

10.

Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP, Larrue V, Lievre M, Leys D, Bonneville JF, Watelet J, Pruvo JP, Albucher JF, Viguier A, Piquet P, Garnier P, Viader F, Touze E, Giroud M, Hosseini H, Pillet JC, Favrole P, Neau JP, Ducrocq X (2006) Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 355:1660–1671PubMedCrossRef

11.

Ringleb PA, Allenberg J, Bruckmann H, Eckstein HH, Fraedrich G, Hartmann M, Hennerici M, Jansen O, Klein G, Kunze A, Marx P, Niederkorn K, Schmiedt W, Solymosi L, Stingele R, Zeumer H, Hacke W (2006) 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 368:1239–1247PubMedCrossRef

12.

Wasser K, Pilgram-Pastor SM, Schnaudigel S, Stojanovic T, Schmidt H, Knauf J, Gröschel K, Knauth M, Hildebrandt H, Kastrup A (2011) New brain lesions after carotid revascularization are not associated with cognitive performance. J Vasc Surg 53:61–70PubMedCrossRef

13.

Altinbas A, van Zandvoort MJ, van den Berg E, Jongen LM, Algra A, Moll FL, Nederkoorn PJ, Mali WP, Bonati LH, Brown MM, Kappelle LJ, van der Worp HB (2011) Cognition after carotid endarterectomy or stenting: a randomized comparison. Neurology 77:1084–1090PubMedCrossRef

14.

Tiemann L, Reidt JH, Esposito L, Sander D, Theiss W, Poppert H (2009) Neuropsychological sequelae of carotid angioplasty with stent placement: correlation with ischemic lesions in diffusion weighted imaging. PLoS ONE 4:e7001PubMedCrossRef

15.

Heyer EJ, Sharma R, Rampersad A, Winfree CJ, Mack WJ, Solomon RA, Todd GJ, McCormick PC, McMurtry JG, Quest DO, Stern Y, Lazar RM, Connolly ES (2002) A controlled prospective study of neuropsychological dysfunction following carotid endarterectomy. Arch Neurol 59:217–222PubMedCrossRef

16.

Witt K, Borsch K, Daniels C, Walluscheck K, Alfke K, Jansen O, Czech N, Deuschl G, Stingele R (2007) Neuropsychological consequences of endarterectomy and endovascular angioplasty with stent placement for treatment of symptomatic carotid stenosis: a prospective randomised study. J Neurol 254:1524–1532PubMedCrossRef

17.

Mocco J, Wilson DA, Komotar RJ, Zurica J, Mack WJ, Halazun HJ, Hatami R, Sciacca RR, Connolly ES Jr, Heyer EJ (2006) Predictors of neurocognitive decline after carotid endarterectomy. Neurosurgery 58:844–850PubMedCrossRef

18.

Group ECST (1991) MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99 %) or with mild (0–29 %) carotid stenosis. European Carotid Surgery Trialists’ Collaborative Group. Lancet 337:1235–1243

19.

Wasser K, Schnaudigel S, Wohlfahrt J, Psychogios MN, Knauth M, Gröschel K (2011) Inflammation and in-stent restenosis: the role of serum markers and stent characteristics in carotid artery stenting. PLoS ONE 6:e22683PubMedCrossRef

20.

Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA (1987) MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol 149:351–356PubMed

21.

Becker M, Sturm W, Willmes K, Zimmermann P (1996) Normierungsstudie zur Aufmerksamkeitsbatterie (TAP) von Zimmermann und Fimm. Zeitschr Neuropsychol 1:3–15

22.

Zimmermann P, Fimm B (1994) Testbatterie zur Aufmerksamkeitsprüfung (TAP). Psytest, Herzogenrath

23.

Aschenbrenner S, Tucha O, Lange K (2000) Regensburger Wortflüssigkeitstest. Swets und Zeitlinger Verlag, Lisse

24.

Regard M, Strauss E, Knapp P (1982) Children’s production on verbal and non-verbal fluency tasks. Percept Mot Skills 55:839–844PubMedCrossRef

25.

Nelson H (1976) A modified card sorting test sensitive to frontal lobe defects. Cortex 12:313–324PubMed

26.

Härting C, Markowitsch H, Neufeld H, Clabrese P, Deisinger K, Kessler J (2000) Wechsler Gedächtnis Test–Revidierte Fassung (WMS-R). Huber, Bern

27.

Buschke H (1973) Selective reminding for analysis of memory and learning. J Verbal Learn Verbal Behav 12:543–550CrossRef

28.

Osterrieth P (1944) Le test de copie d’une figure complexe. Arch Psychol 30:206–353

29.

Sturm W, Willmes K (1999) Nonverbaler Lerntest (NVLT). Hogrefe Verlag für Psychologie, Göttingen

30.

Barbizet J, Cany E (1968) Clinical and psychometrical study of a patient with memory disturbances. Int J Neurol 7:44–54PubMed

31.

Bäumler G (1974) Lern- und Gedächtnistest LGT-3. Hogrefe Verlag für Psychologie, Göttingen

32.

Bonati LH, Fraedrich G (2011) Age modifies the relative risk of stenting versus endarterectomy for symptomatic carotid stenosis—a pooled analysis of EVA-3S, SPACE and ICSS. Eur J Vasc Endovasc Surg 41:153–158PubMedCrossRef

33.

Stingele R, Berger J, Alfke K, Eckstein HH, Fraedrich G, Allenberg J, Hartmann M, Ringleb PA, Fiehler J, Bruckmann H, Hennerici M, Jansen O, Klein G, Kunze A, Marx P, Niederkorn K, Schmiedt W, Solymosi L, Zeumer H, Hacke W (2008) Clinical and angiographic risk factors for stroke and death within 30 days after carotid endarterectomy and stent-protected angioplasty: a subanalysis of the SPACE study. Lancet Neurol 7:216–222PubMedCrossRef

34.

De Rango P, Caso V, Leys D, Paciaroni M, Lenti M, Cao P (2008) The role of carotid artery stenting and carotid endarterectomy in cognitive performance: a systematic review. Stroke 39:3116–3127PubMedCrossRef

35.

Bo M, Massaia M, Speme S, Cappa G, Strumia K, Cerrato P, Ponzio F, Poli L (2006) Risk of cognitive decline in older patients after carotid endarterectomy: an observational study. J Am Geriatr Soc 54:932–936PubMedCrossRef

36.

Gaudet JG, Yocum GT, Lee SS, Granat A, Mikami M, Connolly ES Jr, Heyer EJ (2010) MMP-9 levels in elderly patients with cognitive dysfunction after carotid surgery. J Clin Neurosci 17:436–440PubMedCrossRef

37.

Heyer EJ, Adams DC, Solomon RA, Todd GJ, Quest DO, McMahon DJ, Steneck SD, Choudhri TF, Connolly ES (1998) Neuropsychometric changes in patients after carotid endarterectomy. Stroke 29:1110–1115PubMedCrossRef

38.

Heyer EJ, DeLaPaz R, Halazun HJ, Rampersad A, Sciacca R, Zurica J, Benvenisty AI, Quest DO, Todd GJ, Lavine S, Solomon RA, Connolly ES Jr (2006) Neuropsychological dysfunction in the absence of structural evidence for cerebral ischemia after uncomplicated carotid endarterectomy. Neurosurgery 58:474–480 (discussion 480)

39.

Takaiwa A, Hayashi N, Kuwayama N, Akioka N, Kubo M, Endo S (2009) Changes in cognitive function during the 1-year period following endarterectomy and stenting of patients with high-grade carotid artery stenosis. Acta Neurochir (Wien) 151:1593–1600CrossRef

40.

Newman MF, Croughwell ND, Blumenthal JA, White WD, Lewis JB, Smith LR, Frasco P, Towner EA, Schell RM, Hurwitz BJ et al (1994) Effect of aging on cerebral autoregulation during cardiopulmonary bypass. Association with postoperative cognitive dysfunction. Circulation 90:II243–II249

41.

Gaudet JG, Meyers PM, McKinsey JF, Lavine SD, Gray W, Mitchell E, Connolly ES Jr, Heyer EJ (2009) Incidence of moderate to severe cognitive dysfunction in patients treated with carotid artery stenting. Neurosurgery 65:325–329 (discussion 9–30)

42.

Grunwald IQ, Papanagiotou P, Reith W, Backens M, Supprian T, Politi M, Vedder V, Zercher K, Muscalla B, Haass A, Krick CM (2010) Influence of carotid artery stenting on cognitive function. Neuroradiology 52:61–66PubMedCrossRef

43.

Gröschel K, Ernemann U, Schnaudigel S, Wasser K, Nägele T, Kastrup A (2008) A risk score to predict ischemic lesions after protected carotid artery stenting. J Neurol Sci 273:112–115PubMedCrossRef

44.

Kastrup A, Gröschel K, Nägele T, Riecker A, Schmidt F, Schnaudigel S, Ernemann U (2008) Effects of age and symptom status on silent ischemic lesions after carotid stenting with and without the use of distal filter devices. AJNR Am J Neuroradiol 29:608–612PubMedCrossRef

45.

Hauth EA, Jansen C, Drescher R, Schwartz M, Forsting M, Jaeger HJ, Mathias KD (2005) MR and clinical follow-up of diffusion-weighted cerebral lesions after carotid artery stenting. AJNR Am J Neuroradiol 26:2336–2341PubMed

46.

Schluter M, Tubler T, Steffens JC, Mathey DG, Schofer J (2003) Focal ischemia of the brain after neuroprotected carotid artery stenting. J Am Coll Cardiol 42:1007–1013PubMedCrossRef

47.

Weber CF, Friedl H, Hueppe M, Hintereder G, Schmitz-Rixen T, Zwissler B, Meininger D (2009) Impact of general versus local anesthesia on early postoperative cognitive dysfunction following carotid endarterectomy: GALA Study Subgroup Analysis. World J Surg 33:1526–1532PubMedCrossRef

48.

Heyer EJ, Gold MI, Kirby EW, Zurica J, Mitchell E, Halazun HJ, Teverbaugh L, Sciacca RR, Solomon RA, Quest DO, Maldonado TS, Riles TS, Connolly ES Jr (2008) A study of cognitive dysfunction in patients having carotid endarterectomy performed with regional anesthesia. Anesth Analg 107:636–642PubMedCrossRef

49.

Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, Rabbitt P, Jolles J, Larsen K, Hanning CD, Langeron O, Johnson T, Lauven PM, Kristensen PA, Biedler A, van Beem H, Fraidakis O, Silverstein JH, Beneken JE, Gravenstein JS (1998) Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet 351:857–861PubMedCrossRef

50.

Stanley TO, Mackensen GB, Grocott HP, White WD, Blumenthal JA, Laskowitz DT, Landolfo KP, Reves JG, Mathew JP, Newman MF (2002) The impact of postoperative atrial fibrillation on neurocognitive outcome after coronary artery bypass graft surgery. Anesth Analg 94:290–295PubMed

51.

McKhann GM, Goldsborough MA, Borowicz LM Jr, Selnes OA, Mellits ED, Enger C, Quaskey SA, Baumgartner WA, Cameron DE, Stuart RS, Gardner TJ (1997) Cognitive outcome after coronary artery bypass: a one-year prospective study. Ann Thorac Surg 63:510–515PubMedCrossRef

52.

Weiner DE, Scott TM, Giang LM, Agganis BT, Sorensen EP, Tighiouart H, Sarnak MJ (2011) Cardiovascular disease and cognitive function in maintenance hemodialysis patients. Am J Kidney Dis 58:773–781PubMedCrossRef

53.

Comijs HC, Dik MG, Deeg DJ, Jonker C (2004) The course of cognitive decline in older persons: results from the longitudinal aging study Amsterdam. Dement Geriatr Cogn Disord 17:136–142PubMedCrossRef

Title: Age-dependent effects of carotid endarterectomy or stenting on cognitive performance
Authors: Katrin Wasser
Helmut Hildebrandt
Sonja Gröschel
Tomislav Stojanovic
Holger Schmidt
Klaus Gröschel
Sara M. Pilgram-Pastor
Michael Knauth
Andreas Kastrup
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Journal of Neurology / Issue 11/2012
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-012-6491-9

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Age-dependent effects of carotid endarterectomy or stenting on cognitive performance

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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