Saved in:
| Main Authors: | , |
|---|---|
| Format: | Recurso digital |
| Language: | |
| Published: |
Zenodo
2025
|
| Online Access: | https://doi.org/10.5281/zenodo.17454339 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
Table of Contents:
- Carotid Artery Stenosis is a significant risk factor for ischemic stroke and is linked to cognitive impairment in patients, especially in domains related to memory and executive function. Carotid Endarterectomy (CEA) and Carotid Artery Stenosis (CAS) are protocol interventions for stroke prevention, subsequent restoration of cognitive function by these modalities remains unexplored. Our objective is to review literature and evaluate changes in cognitive function and neural network connectivity post-revascularization, focusing on changes observed in functional MRI (fMRI), a non-invasive method effective in assessing such changes. A comprehensive database search was conducted on PubMed, including terms "cognition", "neurocognitive recovery", "cognitive improvement", "Carotid endarterectomy", "Carotid Stenting", "Carotid Revascularization", "post-operative". A total of 181 results were obtained and screened. The inclusion criteria were as follows: - Focusing on cognitive outcomes post-vascularization - Using fMRI results - Reported both pre-operative and post-operative cognitive assessments using validated tools - Published in English - Involving human subjects Non peer-reviewed studies and studies that focused only on stroke outcomes without cognitive evaluation or did not include neuroimaging or cognitive assessment data were excluded. Based on this, 13 studies were selected and reviewed. Carotid Vascularization shows a consistent improvement in cognitive domains including attention, memory and executive functions. This is demonstrated by neuropsychological assessments like MoCA, MMSE and RBANS. Resting-state fMRI studies demonstrate an enhanced functional connectivity in the default mode network after the procedure, correlating the result to cognitive improvement.MR spectroscopy also suggest a favorable metabolic change in brain regions affected by hypoperfusion. Despite encouraging findings, postoperative cognitive dysfunction (POCD) remains a major concern, risk factors of which include age, diabetes and hypoperfusion. This contributes to a variability in outcomes. Additionally, heterogeneity in study designs as well as small sample sizes and a lack of randomized controlled trials impair the generalization of these results. Regardless of any shortcoming, the accumulating evidence advocates integration of cognitive screening with vascular surgical care. This may provide crucial guidance with regards to patient selection and post-operative follow up, especially in asymptomatic patients. Further research prioritizing multicenter trials with standard cognitive and neuroimaging protocols. Additional focus could be on exploring AI-based predictive tools, and assessing long-term trajectories so as to establish cognitive recovery as a standard endpoint in carotid interventions. Literature positively suggests that carotid revascularization may offer cognitive benefits in addition to its primary purpose of stroke risk reduction. An improvement in cerebral perfusion and restoration of brain network connectivity appears to be the underlying factor for these gains. Clinical incorporation of cognitive screening into preoperative protocols and postoperative follow ups therefore seem to be beneficial. However, limitations including sample sizes, shorter follow up durations and the lack of randomized trials need to be worked upon. Extensive research in this direction, and a resulting incorporation of cognitive recovery as a formal endpoint could redefine and improve the therapeutic scope.