after carotid endarterectomy or stenting: A randomized comparison

Carotid and Cerebrovascular Disease


Cognition after carotid endarterectomy or stenting: A randomized comparison


Altinbas A, van Zandvoort MJE, van den Berg E, et al (Univ Med Ctr Utrecht, The Netherlands; et al) Neurology 77:1084–1090, 2011§



G.L. Moneta, MD



Evidence Ranking


• B



Expert Rating


• 1



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).

Related posts:

  1. Function Testing of Platelets and Long-term Outcome of Patients with Peripheral Arterial Disease Undergoing Transluminal Angioplasty
  2. of Hypoxia-Inducible Factor-1α Gene Therapy on Walking Performance in Patients With Intermittent Claudication
  3. oral antiplatelet therapy may increase the risk of hemorrhagic complications in patients with acute ischemic stroke caused by large artery disease
  4. and Removal of Inferior Vena Cava Filters: National Trends in the Medicare Population

Stay updated, free articles. Join our Telegram channel
Tags:
Apr 1, 2017 | Posted by in CARDIOLOGY | Comments Off on after carotid endarterectomy or stenting: A randomized comparison

Full access? Get Clinical Tree
Get Clinical Tree app for offline access