Neurocognitive functioning after carotid revascularization: a systematic review

Background: The objective of this study was to review the recent literature regarding the neurocognitive consequences of carotid endarterectomy (CEA) and carotid stenting (CAS). Summary: A PubMed and Web of Science search was conducted using the keywords ‘carotid’ in combination with cognitive’, ’cognition’, ‘neurocognition’, ‘neurocognitive’, ‘neuropsychology’, and ‘neuropsychological’. Bibliographies of relevant articles were cross referenced. We included 37 studies published since 2007 of whom 18 examined CEA, 12 CAS, and 7 who compared CEA to CAS. There is a wide variability in the reported neurocognitive outcome following CEA and CAS. Nonetheless, none of the included studies unveiled significant differences between CEA and CAS on postoperative neurocognitive functioning. Postoperative changes observed for CEA and CAS separately, seem limited to a small percentage (around 10 to 15%) of patients and can either present as an improvement or impairment. Key Messages: The available data seem to suggest that no obvious cognitive differences between CAS and CEA can be observed post intervention. Both improvement and deterioration of cognitive functioning can be observed following CAS or CEA. Methodological differences such as patient heterogeneity, implementation and type of control group, type of psychometric tests used, statistical analyses, timing of the assessments, etc play an important role in explaining the sometimes divergent results of the included studies. Large scale and methodologically solid studies comparing CEA and CAS on neurocognitive outcome remain warranted. Future studies should implement adequate control groups to correct for practice effects in the target groups.