Jornal Vascular Brasileiro
Jornal Vascular Brasileiro
Review Article

The impact of carotid revascularization on cognitive function

O impacto da revascularização carotídea sobre a função cognitiva

Germano da Paz Oliveira; Ana Terezinha Guillaumon; Iran Batista de Brito; Joana Mayra Teixeira Lima; Sérgio Clementino Benvindo; Fernando Cendes

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The concept that carotid disease may compromise cognitive function was initially proposed by Fisher in 1951, based on an autopsy case. However, some topics involving cognitive function remain controversial, such as its correlation with carotid obstructive disease. So, the authors of this review evaluate the impact of carotid revascularization on cognitive function and the repercussions of the revascularization technique (carotid stenting vs. endarterectomy) chosen. It was clear from the literature reviewed that carotid stenosis is related to a decline in cognitive function over time. However, controversy still remains over the impact of carotid revascularization on cognitive function. With elation to the technique employed (carotid stenting vs. endarterectomy), the majority of studies found no difference between the two techniques in terms of overall cognitive outcome.


carotid stenosis, therapy, carotid endarterectomy, cognition


A noção de que a doença carotídea pode comprometer a função cognitiva foi proposta inicialmente por Fisher, em 1951, baseado em um caso de necropsia. Porém, alguns tópicos envolvendo a função cognitiva permanecem controversos, tais como sua correlação com a doença obstrutiva da carótida. Nesse sentido, os autores desta revisão buscam avaliar o impacto da revascularização carotídea e a repercussão da técnica de revascularização empregada (endarterectomia versusangioplastia carotídea) sobre a função cognitiva. A partir da literatura levantada, ficou claro que as estenoses carotídeas estão relacionadas com o declínio cognitivo ao longo do tempo, mas ainda há controvérsia no que se refere ao impacto da revascularização carotídea sobre a função cognitiva. Quanto à técnica empregada (angioplastia versusendarterectomia carotídeas), a maioria dos estudos não demonstrou distinção entre as duas técnicas quanto ao desfecho cognitivo geral.


estenose das carótidas, terapia, endarterectomia das carótidas, cognição


Lal BK. Cognitive function after carotid artery revascularization. Vasc Endovasc Surg. 2007;41(1):5-13.

Fisher C. Senile dementia - a new explanation of its causation. Arch Neurol. 1951;65:1-7.

Carrea R, Molins M, Murphy G. Surgery of spontaneous thrombosis of internal carotid in the neck; carotid-carotid anastomosis; case report and analysis of the literature on surgical cases. Medicina (B. Aires). 1955;15:20-9.

DeBakey ME. Successful carotid endarterectomy for cerebrovascular insufficiency. Nineteen-year follow-up. JAMA. 1975;233:1083-5.

Eastcott HH, Pickering GW, Rob CG. Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. Lancet. 1954;267:994-6.

Feliziani FT, Polidori MC, De Rango P. Cognitive performance in elderly patients undergoing carotid endarterectomy or carotid artery stenting: a twelve-month follow-up study. Cerebrovasc Dis. 2010;30:244-51.

Seshadri S, Beiser A, Kelly-Hayes M. The lifetime risk of stroke: estimates from the Framingham study. Stroke. 2006;37:345-50.

Hachinski V. The 2005 Thomas Willis lecture: stroke and vascular cognitive impairment - a transdisciplinary, translational and transactional approach. Stroke. 2007;38:1396.

Desmond DW, Moroney JT, Sano M, Stern Y. Incidence of dementia after ischemic stroke: results of a longitudinal study. Stroke. 2002;33:2254-60.

Rao SM, Leo GJ, Ellington L, Nauertz T, Bernardin L, Unverzagt F. Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning. Neurology. 1991;41:692-6.

Chaytor N, Schmitter-Edgecombe M. The ecological validity of neuropsychological tests: a review of the literature on everyday cognitive skills. Neuropsychol Rev. 2003;13:181-97.

Hachinski V, Iadecola C, Petersen RC. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke. 2006;37:2220-41.

Rasmussen LS. Postoperative cognitive dysfunction: incidence and prevention. Best Pract Res Clin Anaesthesiol. 2006;20:315-30.

Vermeer SE, Prins ND, Den Heijer T, Hofman A, Koudstaal PJ, Breteler MMB. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003;348:1215-22.

Mosley TH Jr, Knopman DS, Catellier DJ. Cerebral MRI findings and cognitive functioning: the Atherosclerosis Risk in Communities Study. Neurology. 2005;64:2056-62.

Longstreth WT Jr, Bernick C, Manolio TA, Bryan N, Jungreis CA, Price TR. Lacunar infarcts defined by magnetic resonance imaging of 3660 elderly people: the Cardiovascular Health Study. Arch Neurol. 1998;55:1217-25.

Capoccia L, Sbarigia E, Rizzo A, Mansour W, Speziale F. Silent stroke and cognitive decline in asymptomatic carotid stenosis revascularization. Vascular. 2012;20(4):181-7.

Braekken SK, Russell D, Brucher R, Abdelnoor M, Svennevig JL. Cerebral microembolic signals during cardiopulmonary bypass surgery. Frequency, time of occurrence, and association with patient and surgical characteristics. Stroke. 1997;28:1988-92.

Braekken SK, Endresen K, Russell D, Brucher R, Kjekshus J. Influence of guidewire and catheter type on the frequency of cerebral microembolic signals during left heart catheterization. Am J Cardiol. 1998;82:632-7.

Braekken SK, Reinvang I, Russell D, Brucher R, Svennevig JL. Association between intraoperative cerebral microembolic signals and postoperative neuropsychological deficit: comparison between patients with cardiac valve replacement and patients with coronary artery bypass grafting. J Neurol Neurosurg Psychiatry. 1998;65:573-6.

Sylivris S, Levi C, Matalanis G. Pattern and significance of cerebral microemboli during coronary artery bypass grafting. Ann Thorac Surg. 1998;66:1674-8.

Laza C, Popescu BO, Popa M. Microemboli detection in patients with carotid artery stenting--a potential marker for future cognitive impairment?. J Neurol Sci.. 2013;326(1-2):96-9.

Crawley F, Stygall J, Lunn S, Harrison M, Brown MM, Newman S. Comparison of microembolism detected by transcranial Doppler and neuropsychological sequelae of carotid surgery and percutaneous transluminal angioplasty. Stroke. 2000;31:1329-34.

Jordan WD Jr, Voellinger DC, Doblar DD, Plyushcheva NP, Fisher WS, McDowell HA. Microemboli detected by transcranial Doppler monitoring in patients during carotid angioplasty versus carotid endarterectomy. Cardiovasc Surg. 1999;7:33-8.

Wolf O, Heider P, Heinz M. Microembolic signals detected by transcranial doppler sonography during carotid endarterectomy and correlation with serial diffusionweighted imaging. Stroke. 2004;35:e373-5.

Ghogawala Z, Westerveld M, Amin-Hanjani S. Cognitive outcomes after carotid revascularization: the role of cerebral emboli and hypoperfusion. Neurosurg. 2008:385-95.

Ringelstein EB, Droste DW, Babikian VL. Consensus on microembolus detection by TCD. International Consensus Group on Microembolus Detection. Stroke. 1998;29:725-9.

Gaunt ME, Smith JL, Bell PR, Martin PJ, Naylor AR. Microembolism and hemodynamic changes in the brain during carotid endarterectomy. Stroke. 1994;25:2504-5.

Chen CI, Iguchi Y, Garami Z. Analysis of emboli during carotid stenting with distal protection device. Cerebrovasc Dis. 2006;21:223-8.

Gupta N, Corriere MA, Dodson TF. The incidence of microemboli to the brain is less with endarterectomy than percutaneous revascularization with distal filters or flow reversal. J Vasc Surg. 2011;53:316-22.

Capoccia L, Speziale F, Gazzetti M. Comparative study on carotid revascularization(endarterectomy vs stenting) using markers of cellular brain injury, neuropychometric tests, and diffusion-weighted magnetic resonance imaging. J Vasc Surg. 2010;51:584-92.

Roh HG, Byun HS, Ryoo JW. Prospective analysis of cerebral infarction after carotid endarterectomy and carotid artery stent placement by using diffusion-weighted imaging. Am J Neuroradiol. 2005;26:376-84.

Rapp JH, Wakil L, Sawhney R. Subclinical embolization after carotid artery stenting:new lesions on diffusion-weighted magnetic resonance imaging occur postprocedure. J Vasc Surg. 2007;45:867-74.

Hauth EA, Jansen C, Drescher R. MR and clinical follow-up of diffusion-weighted cerebral lesions after carotid artery stenting. Am J Neuroradiol. 2005;26:2336-4.

Fearn SJ, Pole R, Wesnes K, Faragher EB, Hooper TL, McCollum CN. Cerebral injury during cardiopulmonary bypass: Emboli impair memory. J Thorac Cardiovasc Surg. 2001;121:1150-60.

Sasoh M, Ogasawara K, Kuroda K. Effects of EC-IC bypass surgery on cognitive impairment in patients with hemodynamic cerebral ischemia. Surg Neurol. 2003;59:455-60.

Younkin D, Hungerbuhler JP, O'Connor M. Superficial temporal-middle cerebral artery anastomosis: effects on vascular, neurologic, and neuropsychological functions. Neurology. 1985;35:462-9.

Marshall RS, Lazar RM, Pile-Spellman J. Recovery of brain function during induced cerebral hypoperfusion. Brain. 2001;124:1208-17.

Borroni B, Tiberio G, Bonardelli S. Is mild vascular cognitive impairment reversible? Evidence from a study on the effect of carotid endarterectomy. Neurol Res. 2004;26:594-7.

Costin M, Rampersad A, Solomon RA, Connolly ES, Heyer EJ. Cerebral injury predicted by transcranial Doppler ultrasonography but not electroencephalography during carotid endarterectomy. J Neurosurg Anesthesiol. 2002;14:287-92.

Heyer EJ, Adams DC, Solomon RA. Neuropsychometric changes in patients after carotid endarterectomy. Stroke. 1998;29:1110-5.

Ogasawara K, Inoue T, Kobayashi M. Cognitive impairment associated with intraoperative and postoperative hypoperfusion without neurologic deficits in a patient undergoing carotid endarterectomy. Surg Neurol. 2006;65:577-81.

Lund C, Hol PK, Lundblad R. Comparison of cerebral embolization during off-pump and on-pump coronary artery bypass surgery. Ann Thorac Surg. 2003;76:765-70.

Sundt TM, Sharbrough FW, Piepgras DG, Kearns TP, Messick JM, O'Fallon WM. Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy: With results of surgery and hemodynamics of cerebral ischemia. Mayo Clin Proc. 1981;56:533-43.

Halsey JH. Risks and benefits of shunting in carotid endarterectomy. The International Transcranial Doppler Collaborators. Stroke. 1992;23:1583-7.

Lawrence PF, Alves JC, Jicha D, Bhirangi K, Dobrin PB. Incidence, timing, and causes of cerebral ischemia during carotid endarterectomy with regional anesthesia. J Vasc Surg. 1998;27:329-37.

Calderon-Arnulphi M, Alaraj A, Amin-Hanjani S. Detection of cerebral ischemia in neurovascular surgery using quantitative frequency-domain near-infrared spectroscopy. J Neurosurg. 2007;106:283-90.

White PF. Use of cerebral monitoring during anaesthesia. Effect on recovery profile. Best Pract Res Clin Anaesthesiol. 2006;20:181-9.

Mendelsohn FO, Weissman NJ, Lederman RJ. Acute hemodynamic changes during carotid artery stenting. Am J Cardiol. 1998;82:1077-81.

Trocciola SM, Chaer RA, Lin SC. Analysis of parameters associated with hypotension requiring vasopressor support after carotid angioplasty and stenting. J Vasc Surg. 2006;43:714.

Gupta R, Abou-Chebl A, Bajzer CT, Schumacher HC, Yadav JS. Rate, predictors, and consequences of hemodynamic depression after carotid artery stenting. J Am Coll Cardiol. 2006;47:1538-43.

Park B, Shapiro D, Dahn M, Arici M. Carotid artery angioplasty with stenting and postprocedure hypotension. Am J Surg. 2005;190:691-5.

Connolly ES, Winfree CJ, Rampersad A. Serum S100B protein levels are correlated with subclinical neurocognitive declines after carotid endarterectomy. Neurosurg. 2001;49:1076-83.

Lunn S, Crawley F, Harrison MJ, Brown MM, Newman SP. Impact of carotid endarterectomy upon cognitive functioning. A systematic review of the literature. Cerebrovasc Dis. 1999;9:74-81.

Irvine CD, Gardner FV, Davies AH, Lamont PM. Cognitive testing in patients undergoing carotid endarterectomy. Eur J Vasc Endovasc Surg. 1998;15:195-204.

Heyer EJ, Sharma R, Rampersad A. A controlled prospective study of neuropsychological dysfunction following carotid endarterectomy. Arch Neurol. 2002;59:217-22.

Hobson RW. Update on the Carotid Revascularization Endarterectomy versus Stent Trial (CREST) protocol. J Am Coll Surg. 2002;194(^s1 suppl):S9-14.

Xu G, Liu X, Meyer JS, Yin Q, Zhang R. Cognitive performance after carotid angioplasty and stenting with brain protection devices. Neurol Res. 2007;29:251-5.

No authors listed. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS):a randomised trial. Lancet. 2001;357:1729-37.

Grunwald I, Suppurian T, Struffert T, Falkai P, Krick C, Politi M. Cognitive Changes after Carotid Artery Stenting. Neuroradiology. 2006;48:319-23.

Mlekusch W, Mlekusch I, Haumer M, Kopp CW, Lehrner J, Ahmadi R. Improvement of neurocognitive function after protected carotid artery stenting. Catheter Cardiovasc Interv. 2008;71(1):114-9.

Gaudet JG, Meyers PM, McKinsey JF. Incidence of moderate to severe cognitive dysfunction in patients treated with carotid artery stenting. Neurosurgery. 2009;65(2):325-9.

Lal BK, Younes M, Cruz G, Kapadia I, Jamil Z, Pappas PJ. Cognitive changes after surgery vs stenting for carotid artery stenosis. J Vasc Surg. 2011;54(3):691-8.

Takaiwa A, Hayashi N, Kuwayama N, Akioka N, Kubo M, Endo S. Changes in cognitive function during the 1-year period following endarterectomy and stenting of patients with high-grade carotid artery stenosis. Acta Neurochir. 2009;151:1593-600.

Zhou W, Hitchner E, Gillis K. Prospective neurocognitive evaluation of patients undergoing carotid interventions. J Vasc Surg. 2012;56(6):1571-8.

Altinbas A, van Zandvoort MJ, van den Berg E. Cognition after carotid endarterectomy or stenting: a randomized comparison. Neurology. 2011;77(11):1084-90.

Witt K, Börsch K, Daniels C. Neuropsychological consequences of endarterectomy and endovascular angioplasty with stent placement for treatment of symptomatic carotid stenosis: a prospective randomised study. J Neurol. 2007;254(11):1524-32.

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