• Mary C Zuniga, Thuy B Tran, Brittanie D Baughman, Gayatri Raghuraman, Elizabeth Hitchner, Allyson Rosen, and Wei Zhou.
• *VA Palo Alto Health Care System, Palo Alto, CA †Department of Surgery, Stanford University, Stanford, CA ‡Department of Psychiatry, Stanford University, Stanford, CA.
• Ann. Surg. 2016 Oct 1; 264 (4): 659-65.

ObjectiveTo determine factors affecting cognition and identify predictors of long-term cognitive impairment following carotid revascularization procedures.BackgroundCognitive impairment is common in older patients with carotid occlusive diseases.MethodsPatients undergoing carotid intervention for severe occlusive diseases were prospectively recruited. Patients received neurocognitive testing before, 1, and 6 months after carotid interventions. Plasma samples were also collected within 24 hours after carotid intervention and inflammatory cytokines were analyzed. Univariate and multivariate logistic regressions were performed to identify risk factors associated with significant cognitive deterioration (>10% decline).ResultsA total of 98 patients (48% symptomatic) were recruited, including 55 patients receiving carotid stenting and 43 receiving endarterectomy. Mean age was 69 (range 54-91 years). Patients had overall improvement in cognitive measures 1 month after revascularization. When compared with carotid stenting, endarterectomy patients demonstrated postoperative improvement in cognition at 1 and 6 months compared with baseline. Carotid stenting (odds ratio 6.49, P = 0.020) and age greater than 80 years (odds ratio 12.6, P = 0.023) were associated with a significant long-term cognitive impairment. Multiple inflammatory cytokines also showed significant changes after revascularization. On multivariate analysis, after controlling for procedure and age, IL-12p40 (P = 0.041) was associated with a higher risk of significant cognitive impairment at 1 month; SDF1-α (P = 0.004) and tumor necrosis factor alpha (P = 0.006) were independent predictors of cognitive impairment, whereas interleukin-6 (P = 0.019) demonstrated cognitive protective effects at 6 months after revascularization.ConclusionsCarotid interventions affect cognitive function. Systemic biomarkers can be used to identify patients at risk of significant cognitive decline postprocedures that benefit from targeted cognitive training.

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