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Observational Study
. 2024 Feb 21;47(1):91.
doi: 10.1007/s10143-024-02324-0.

Association between preoperative white matter hyperintensities and postoperative new ischemic lesions on magnetic resonance imaging in patients with cognitive decline after carotid endarterectomy

Ryouga Yamazaki  1 , Yosuke Akamatsu  1 , Jun Yoshida  1 , Fumio Yamashita  2 , Makoto Sasaki  2 , Shunrou Fujiwara  1 , Masakazu Kobayashi  1 , Takahiro Koji  1 , Kuniaki Ogasawara  3
Affiliations
Observational Study

Association between preoperative white matter hyperintensities and postoperative new ischemic lesions on magnetic resonance imaging in patients with cognitive decline after carotid endarterectomy

Ryouga Yamazaki et al. Neurosurg Rev. .

Abstract

Although cognitive decline after carotid endarterectomy (CEA) is mainly related to postoperative cerebral hyperperfusion, approximately 30% of patients with cognitive decline do not have postoperative cerebral hyperperfusion. In patients with acute ischemic events, the development of cognitive decline after such events is associated with the presence of chronic cerebral white matter hyperintensities (WMHs). The present prospective observational study aimed to determine whether preoperative WMHs and postoperative new ischemic lesions (PNILs) are associated with cognitive decline after CEA in patients without cerebral hyperperfusion after CEA. Brain magnetic resonance imaging (MRI) was performed preoperatively, and WMHs were graded according to the Fazekas scale in patients undergoing CEA for severe stenosis of the ipsilateral internal carotid. Diffusion-weighted MRI was performed before and after CEA to determine the development of PNILs. Neuropsychological testing was performed preoperatively and at 2 months postoperatively to determine the development of postoperative cognitive decline (PCD). In 142 patients without postoperative cerebral hyperperfusion, logistic regression analysis revealed that preoperative Fazekas scale of periventricular WMHs (PVWMHs) (95% confidence interval [CI]: 1.78-28.10; P = 0.0055) and PNILs in the eloquent areas (95% CI: 7.42-571.89; P = 0.0002) were significantly associated with PCD. The specificity and positive-predictive value for the prediction of PCD were significantly greater for the combination of preoperative Fazekas scale 2 or 3 of PVWMHs and PNILs in the eloquent areas than for each individually. Preoperative PVWMHs, PNILs in the eloquent areas, and the combination of both were associated with PCD in patients without cerebral hyperperfusion after CEA.

Keywords: Acute ischemic lesions; Carotid endarterectomy; Cognition; White matter hyperintensities.

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References

    1. Bonati LH, Kakkos S, Berkefeld J et al (2021) European Stroke Organisation guideline on endarterectomy and stenting for carotid artery stenosis. Eur Stroke J 6:1–47 - DOI
    1. Mantese VA, Timaran CH, Chiu D, Begg RJ, Brott TG (2010) The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke 41:S31–S34 - DOI - PubMed - PMC
    1. Yoshida K, Ogasawara K, Kobayashi M et al (2012) Improvement and impairment in cognitive function after carotid endarterectomy: comparison of objective and subjective assessments. Neurol Med Chir (Tokyo) 52:154–160 - DOI - PubMed
    1. Piepgras DG, Morgan MK, Sundt TM Jr, Yanagihara T, Mussman LM (1988) Intracerebral hemorrhage after carotid endarterectomy. J Neurosurg 68:532–536 - DOI - PubMed
    1. Igarashi S, Ando T, Takahashi T et al (2021) Development of cerebral microbleeds in patients with cerebral hyperperfusion following carotid endarterectomy and its relation to postoperative cognitive decline. J Neurosurg 135:1122–1128 - DOI - PubMed

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