The possible benefits of carotid endarterectomy for cognition and wellbeing in patients with a severe stenosis

Abstract

Carotid endarterectomy (CEA) is indicatively undertaken in patients suffering from severe symptomatic or asymtomatic atherosclerotic stenosis. CEA restores blood flow to the brain, and prevents future stroke. Atherosclerotic stenosis results in a decline of attentional and memory functions, although effects from normal aging are difficult to rule out. Restoration of blood flow predicts improvement of cognitive functions, according to many authors in this field. Despite of the existence of collaterals by way of the Circle of Willis, this may especially hold for those functions that are localized in the hemisphere ipsilateral to the side of operation. Evidence for improvement however is controversial, even if valid instruments for assessment of hemispheric functions are applied. Improvement of function, if found, seems to be nonspecific and not ipsilaterally bound. Moreover, perioperative embolism after CEA may result in cognitive deterioration. This has also been concluded from cognitive evaluation after open heart surgery, such as coronary artery bypass graft (CABG). Nevertheless, unlike other studies, our research has shown that, following CEA, there are clear positive effects of quality of life. The role of quality of life and micro-embolism as possible predictors for postoperative cognitive change is discussed.