TY - JOUR
TI - The Impact of Carotid Artery Stenting on Cognitive Function in Patients
with Extracranial Carotid Artery Stenosis
AU - Antonopoulos, Constantine N.
AU - Kakisis, John D.
AU - Sfyroeras, George
AU - S.
AU - Moulakakis, Konstantinos G.
AU - Kallinis, Aristides and
AU - Giannakopoulos, Triantafillos
AU - Liapis, Christos D.
JO - Annals of Vascular Surgery
PY - 2015
VL - 29
TODO - 3
SP - null
PB - EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
SN - 0890-5096
TODO - 10.1016/j.avsg.2014.10.024
TODO - null
TODO - Background: The effect of carotid artery stenting (CAS) on cognitive
function in patients with extracranial carotid artery stenosis is
equivocal. The aim of this study was to examine the impact of CAS on
various domains of cognitive function.
Methods: We performed a meta-analysis of the studies evaluating various
domains of cognitive function before and after CAS, namely, (1) global
cognition using Mini-Mental State Examination (MMSE) and Rey Auditory
Verbal Learning Test (RAVLT), (2) executive function using Trail Making
Test (TMT) A or Color Trails Test (CTT) A and TMT B or CTT B, (3)
language ability using Boston Naming Test (BNT), (4) memory, (5)
attention/psychomotor speed, and (6) functional ability, using various
cognitive tests. Pooled weighted mean differences (WMDs) and
standardized mean differences (SMDs) with 95% confidence intervals
(95% CIs) were appropriately calculated using fixed or random effects
models after assessing between-study heterogeneity. Meta-regression
analysis was performed with number of patients per study; mean age
(years); follow-up (months); proportion of men; proportion of patients
with hypertension, diabetes mellitus, hyperlipidemia, smoking, and
coronary artery disease; proportion of symptomatic patients; and degree
of ipsilateral and degree of contralateral carotid stenosis as
covariates.
Results: Sixteen studies were eligible, including a total of 626 CAS
patients. A statistically significant improvement of global cognition
was detected with MMSE (WMD = 0.67, 95% CI = 0.29-1.05, P < 0.001;
follow-up = 5.6 months), but not with RAVLT (SMD = 0.45, 95% CI = -0.03
to 0.93, P = 0.07; follow-up = 2.4 months). Significant improvement of
memory (SMD = 0.33, 95% CI = 0.11-0.55, P < 0.01; follow-up = 4.1
months) and attention/psychomotor speed (SMD = 0.21, 95% CI =
0.04-0.39, P = 0.02; follow-up = 4 months) was also detected. No
statistically significant effect on executive function (TMT A/CTT A and
TMT B/CTT B; SMD = 0.08, 95% CI = -0.10 to 0.26, P = 0.39; follow-up =
3.9 months and SMD = -0.02, 95% CI = -0.20 to 0.16, P = 0.82,
respectively; follow-up = 3.9 months), language ability (BNT; SMD =
0.24, 95% CI = -0.05 to 0.54, P = 0.10; follow-up = 4 months), and
functional ability (SMD = -0.05, 95% CI = -0.25 to 0.15, P = 0.63;
follow-up = 3.8 months) was observed. No significant effects of the
examined covariates were demonstrated in the meta-regression analyses.
Conclusions: CAS may be associated with improvement in global cognition,
memory, and attention/psychomotor speed. There was no positive effect on
executive function, language, and functional ability, but CAS was not
associated with a decline in any area of cognitive function. Future
studies in larger groups of patients are probably needed to fully
investigate the long-term effect of CAS on cognition in patients with
carotid artery stenosis.
ER -