COGNITIVE PERFORMANCE CHANGE IN PATIENTS WITH CAROTID ARTERY STENOSIS UNDERGOING SURGICAL REVASCULARIZATION PDF Download
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Author: Simona Lattanzi
Publisher:
ISBN:
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Languages : en
Pages :
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Background and Aims: The effects of carotid revascularization on the neurocognitive functioning still remains elusive. The aim of this study was to evaluate the changes in cognitive performance and their predictors in patients with symptomatic high-grade internal carotid artery (ICA) stenosis undergoing carotid endarterectomy (CEA). Methods: Participants were patients who underwent CEA and had history of transient ischemic attack within the past 6 months due to ipsilateral severe ICA stenosis. Coloured Progressive Matrices plus Complex Figure Copy Test, and phonemic plus categorical Verbal Fluency tests were performed to assess right and left hemisphere cognitive functions, respectively. Cerebral hemodynamics was assessed with transcranial Doppler ultrasonography by means of the cerebral vasomotor reactivity (CVR) to hypercapnia.Results: One hundred and ninety patients were enrolled. At 6 months from CEA, the scores obtained in the cognitive tests exploring the re-vascularized hemisphereu2019s functions and ipsilateral cerebral hemodynamics were significantly improved. At multivariate linear regression analysis, the change in cognitive performance was inversely associated with age [u00df=-0.17, 95% confidence interval (CI) -0.23 to -0.12; p
Author: Simona Lattanzi
Publisher:
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Category :
Languages : en
Pages :
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Book Description
Background and Aims: The effects of carotid revascularization on the neurocognitive functioning still remains elusive. The aim of this study was to evaluate the changes in cognitive performance and their predictors in patients with symptomatic high-grade internal carotid artery (ICA) stenosis undergoing carotid endarterectomy (CEA). Methods: Participants were patients who underwent CEA and had history of transient ischemic attack within the past 6 months due to ipsilateral severe ICA stenosis. Coloured Progressive Matrices plus Complex Figure Copy Test, and phonemic plus categorical Verbal Fluency tests were performed to assess right and left hemisphere cognitive functions, respectively. Cerebral hemodynamics was assessed with transcranial Doppler ultrasonography by means of the cerebral vasomotor reactivity (CVR) to hypercapnia.Results: One hundred and ninety patients were enrolled. At 6 months from CEA, the scores obtained in the cognitive tests exploring the re-vascularized hemisphereu2019s functions and ipsilateral cerebral hemodynamics were significantly improved. At multivariate linear regression analysis, the change in cognitive performance was inversely associated with age [u00df=-0.17, 95% confidence interval (CI) -0.23 to -0.12; p
Author: Peter Schneider
Publisher: CRC Press
ISBN: 1000611388
Category : Medical
Languages : en
Pages : 346
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Book Description
From patient selection and monitoring to follow-up care, Carotid Interventions is the first source to offer a practical how-to approach to carotid angioplasty and stenting-providing maneuvers and strategies for difficult situations, as well as step-by-step guidance on specific surgical procedures, equipment selection and instrumentation, protection
Author: Marlene Heinze
Publisher:
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Languages : en
Pages :
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Background and Aims:There is evidence suggesting a detrimental effect of asymptomatic carotid artery stenosis on cognitive function even in the absence of ischemic cerebral lesions. Hypoperfusion has been suggested as pathophysiological mechanism causing cognitive impairment. We aimed to assess cognitive performance and cerebral perfusion changes in patients with carotid artery stenosis without ischemic lesions by contrast enhanced (CE) perfusion MRI before and after revascularization therapy.Methods:17 asymptomatic patients with unilateral high-grade (u226570%) carotid artery stenosis without evidence of structural brain lesions underwent CE perfusion MRI and cognitive testing (MMSE, DemTect, Clock-Drawing Test, Trail-Making Test, Stroop Test) before and 6-8 weeks after revascularization therapy by endarterectomy or stenting. Multiparametric perfusion maps (cerebral blood flow (CE-CBF), mean transit time (CE-MTT), cerebral blood volume (CE-CBV)) were calculated and analyzed by vascular territory. Relative perfusion values were calculated. Results:Multivariate analysis revealed a significant impact of revascularization therapy on all perfusion measures analyzed. At baseline post-hoc testing showed significant hypoperfusion in MCA borderzones as assessed by CE-MTT and CE-CBV, but not in CE-CBF. All perfusion alterations normalized after revascularization. We did not observe any significant correlation of cognitive test results with perfusion parameters. There was no significant change in cognitive performance after revascularization.Conclusions:We found evidence of traceable perfusion alterations in patients with high grade carotid artery stenosis in the absence of structural brain lesions, which proved fully reversible after revascularization therapy. In this cohort of asymptomatic patients we did not observe an association of hypoperfusion with cognitive performance.
Author: Julian Schroeder
Publisher:
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Languages : en
Pages :
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Several studies have suggested a correlation between impairment of cognitive function and asymptomatic carotid artery stenosis without ischemic cerebral brain lesions. Hypoperfusion has been discussed as a possible underlying pathophysiological cause. It remains unclear whether hypoperfusion alone without evidence of infarction is sufficient to cause cognitive decline. In this study, we evaluated cognitive performance and cerebral perfusion changes in patients with asymptomatic carotid artery stenosis by arterial spin labeling (ASL) perfusion MRI before and after revascularization therapy.Methods:17 asymptomatic patients with unilateral high-grade (u226570%) carotid artery stenosis without evidence of structural brain lesions underwent ASL perfusion MRI and cognitive testing (MMSE, DemTect, Clock-Drawing Test, Trail-Making Test, Stroop Test) before and 6-8 weeks after revascularization therapy by endarterectomy or stenting. Multiparametric perfusion maps (cerebral blood flow (ASL-CBF), bolus arrival time (ASL-BAT)) were calculated and analyzed by vascular territory. Relative perfusion values were calculated. Results:A significant impact of revascularization therapy was shown through multivariate analysis on all perfusion measures analyzed. MCA borderzones were identified as territories showing significant hypoperfuion at baseline post-hoc testing in both ASL-CBF and ASL-BAT. All perfusion alterations normalized after revascularization. No significant correlation of cognitive test results with perfusion parameters was observed. Cognitive Performance showed no significant change after revascularization. Conclusion:Our study was able to show perfusion alterations in asymptomatic patients with high grade carotid artery stenosis in the absence of structural brain lesions, which proved fully reversible after revascularization therapy. In this cohort of asymptomatic patients we did not observe an association of hypoperfusion with cognitive performance.
Author: Terina Myers
Publisher:
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Languages : en
Pages :
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Background and Aims: We wanted to determine baseline cognition via telephone assessment among individuals in CREST-2 (clinicaltrials.gov NCT02089217), which enrolls cognitively competent individuals with asymptomatic carotid artery occlusive disease or remotely symptomatic atherosclerotic stenosis. Participants undergo baseline cognitive assessment before revascularization or starting medical management alone, and at periodic follow-up. To minimize assessment variability of cognition across >120 CREST-2 centers, we employ centrally-administered telephone assessments, based on the population-based REGARDS cohort study. Methods: Data came from the first 1,000 patients . We used the REGARDS protocol of CERAD Word List Learning (WLL-Sum) and Delayed Recall (WLL-Delay), and Word Fluency for the letter u201cFu201d and Animal Names. Using the general population norms from REGARD (N>23,000), we calculated Z-scores for each CREST-2 test, based on the mean score for age-sex-education matched REGARDS participants.Results: The mean age was 69 yrs, 59%M, and 47% left-sided stenosis. Among our tests, the burden of impairment was found in WLL Learning (p
Author: Fanny Quandt
Publisher:
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Languages : en
Pages :
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Carotid artery stenosis is a well-known risk factor for ischemic stroke. Moreover, even in the absence of stroke, asymptomatic carotid stenosis has been associated with cognitive impairment. It has been suggested that disturbed functional brain connectivity might underlie cognitive impairment in asymptomatic carotid stenosis in the absence of structural brain damage. If so, then carotid revascularization should have an effect on the hypothesized brain network disturbances in these patients. We studied resting-state 64-channel EEG in 12 patients with high grade (u226570%) asymptomatic carotid stenosis before and 6 - 8 weeks after revascularization (carotid endarterectomy or carotid artery stenting). Data were compared with 23 controls of comparable age. We investigated the imaginary EEG coherence in a motor network located within the affected (stenosis side) and unaffected middle cerebral artery territory. At baseline, we observed decreased connectivity of the alpha (8 u2013 13 Hz) and beta (14 u2013 25 Hz) frequency band of EEG oscillations in patients with carotid stenosis compared with healthy controls, particularly on the affected side. After revascularization, a significant increase of functional connectivity was observed. At 6 u2013 8 weeks after revascularization, patients did not significantly differ from healthy controls anymore. In summary, we identified oscillatory connectivity changes in asymptomatic patients with impaired brain perfusion resulting from carotid artery stenosis, that normalized after restoration of cerebral blood flow. Hence, electrophysiological changes might be a reversible precursor preceding macroscopic structural damage and behavioral impairment in patients with asymptomatic carotid stenosis.
Author: Jack M. Guralnik
Publisher: DIANE Publishing
ISBN: 0788131222
Category :
Languages : en
Pages : 407
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Book Description
Designed to help in the understanding of the causes & course of disability in older women. Offers an excellent overview of diseases & disability & their impact on older women. Covers: adaptation to disability, physical performance measures, the daily lives of disabled older women, utilization of health services, mental health & general well-being, pulmonary diseases & conditions, musculoskeletal disease, neurological conditions, vision & hearing, medication use, instrumental & emotional support, adaptation to disability, & much more.
Author: David P. Taggart
Publisher: Oxford University Press, USA
ISBN: 0198758782
Category : Medical
Languages : en
Pages : 521
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Book Description
This is the most authoritative textbook ever dedicated to the art and science of surgical coronary revascularization, with 71 chapters, organized in 9 sections, and written by over 100 recognized world experts. It covers every aspect of the surgical management of coronary artery pathology and ischaemic heart disease.
Author: Michel T. Torbey
Publisher: Cambridge University Press
ISBN: 1107634725
Category : Medical
Languages : en
Pages : 395
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Book Description
An essential companion for busy professionals seeking to navigate stroke-related clinical situations successfully and make quick informed treatment decisions.
Author: Alexander Tsiskaridze
Publisher: Cambridge University Press
ISBN: 1107037433
Category : Medical
Languages : en
Pages : 289
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Book Description
This major new book examines all causes of treatment-related stroke, highlighting therapeutic approaches.
