Neuropsychometric changes in patients after carotid endarterectomy

Abstract

Background and purpose: One hundred twelve patients undergoing elective carotid endarterectomy for symptomatic and asymptomatic carotid artery stenosis were enrolled in a prospective study to evaluate the incidence of change in postoperative cerebral function.

Methods: Patients were evaluated preoperatively and postoperatively before hospital discharge and at follow-up 1 and 5 months later with a battery of neuropsychometric tests. The results were analyzed by both event-rate and group-rate analyses. For event-rate analysis, change was defined as either a decline or improvement in postoperative neuropsychometric performance by 25% or more compared with a preoperative baseline.

Results: Approximately 80% of patients showed decline in one or more test scores, and 60% had one or more improved test scores at the first follow-up examination. The percentage of declined test scores decreased and the percentage of improved test scores increased with subsequent follow-up examinations. Group-rate analysis was similar for group performance on individual tests. However, a decline in performance was seen most commonly on verbal memory tests, and improved performance was seen most commonly on executive and motor tests.

Conclusions: Neuropsychometric evaluation of patients undergoing carotid endarterectomy for significant carotid artery stenosis demonstrates both declines and improvements in neuropsychometric performance. The test changes that showed decreased performance may be associated with ischemia from global hypoperfusion or embolic phenomena, and the improvement seen may be related to increased cerebral blood flow from removal of stenosis.

Percentage of patients showing a decline (top) or improvement (bottom) in neuropsychological test performance as a function of the specific tests. The eight tests are noted on the bottom for both graphs. TrailsA indicates Halstead-Reiten Trails A test; TrailsB, Halstead-Reiten Trails B test; FT, Fine Finger Tapping test; Dom, dominant hand; ND, nondominant hand; PB, Grooved Pegboard test; #1 FU, first follow-up examination; #2 FU, second follow-up examination; and #3 FU, third follow-up examination.