{"title":"Neurocognitive Changes and Cerebral Blood Flow in Patients with Symptomatic Carotid Artery Stenosis before and after Carotid Endarterectomy.","authors":"Yu Xiao, Shifang Li, Yongli Bo, Yingbin Jiao, Changqing Ding, Hongye Yang","doi":"10.3340/jkns.2025.0248","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Carotid endarterectomy (CEA) reduces stroke risk in carotid stenosis patients, with potential but unclear benefits on cognitive function and cerebral blood flow (CBF). This study aimed to assess cognitive and CBF changes after CEA in patients with transient ischemic attack (TIA) and severe symptomatic carotid artery stenosis, exploring the relationship between these changes.</p><p><strong>Methods: </strong>In this prospective, observational study was conducted at Affiliated Hospital of Qingdao University between June 2021 and September 2022, and included patients with recent TIA and confirmed severe symptomatic carotid artery stenosis underwent CEA. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA), and CBF was assessed through arterial spin labeling magnetic resonance imaging (MRI). Measurements were taken preoperatively and at 1 and 6 months postoperatively. Statistical analysis involved paired and independent t-tests, with p<0.05 considered significant.</p><p><strong>Results: </strong>Forty-one patients (average age, 66.8 years; 75.6% male) were assessed. Initially, patients with left internal carotid artery (ICA) stenosis demonstrated naming ability scores significantly lower (2.8±0.4) than controls (3.0±0.2; p<0.05). Right ICA stenosis patients exhibited reduced MoCA scores (21.5±4.3) compared to controls (24.8±3.6, p<0.05). Significant improvements in cognitive performance and CBF were observed 1 month post-surgery, with sustained gains by 6 months. A positive association (R=0.437, p<0.01) was identified between increased CBF and cognitive improvement.</p><p><strong>Conclusion: </strong>CEA may enhance cognitive function and CBF in patients with severe symptomatic carotid artery stenosis. The association between cognitive gains and increased CBF suggests cerebral hemodynamics may play a role as a potentially reversible factor influencing cognitive dysfunction in this population.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":"69 5","pages":"725-733"},"PeriodicalIF":1.9000,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549773/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Korean Neurosurgical Society","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3340/jkns.2025.0248","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/8/31 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Carotid endarterectomy (CEA) reduces stroke risk in carotid stenosis patients, with potential but unclear benefits on cognitive function and cerebral blood flow (CBF). This study aimed to assess cognitive and CBF changes after CEA in patients with transient ischemic attack (TIA) and severe symptomatic carotid artery stenosis, exploring the relationship between these changes.
Methods: In this prospective, observational study was conducted at Affiliated Hospital of Qingdao University between June 2021 and September 2022, and included patients with recent TIA and confirmed severe symptomatic carotid artery stenosis underwent CEA. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA), and CBF was assessed through arterial spin labeling magnetic resonance imaging (MRI). Measurements were taken preoperatively and at 1 and 6 months postoperatively. Statistical analysis involved paired and independent t-tests, with p<0.05 considered significant.
Results: Forty-one patients (average age, 66.8 years; 75.6% male) were assessed. Initially, patients with left internal carotid artery (ICA) stenosis demonstrated naming ability scores significantly lower (2.8±0.4) than controls (3.0±0.2; p<0.05). Right ICA stenosis patients exhibited reduced MoCA scores (21.5±4.3) compared to controls (24.8±3.6, p<0.05). Significant improvements in cognitive performance and CBF were observed 1 month post-surgery, with sustained gains by 6 months. A positive association (R=0.437, p<0.01) was identified between increased CBF and cognitive improvement.
Conclusion: CEA may enhance cognitive function and CBF in patients with severe symptomatic carotid artery stenosis. The association between cognitive gains and increased CBF suggests cerebral hemodynamics may play a role as a potentially reversible factor influencing cognitive dysfunction in this population.
期刊介绍：
The Journal of Korean Neurosurgical Society (J Korean Neurosurg Soc) is the official journal of the Korean Neurosurgical Society, and published bimonthly (1st day of January, March, May, July, September, and November). It launched in October 31, 1972 with Volume 1 and Number 1. J Korean Neurosurg Soc aims to allow neurosurgeons from around the world to enrich their knowledge of patient management, education, and clinical or experimental research, and hence their professionalism. This journal publishes Laboratory Investigations, Clinical Articles, Review Articles, Case Reports, Technical Notes, and Letters to the Editor. Our field of interest involves clinical neurosurgery (cerebrovascular disease, neuro-oncology, skull base neurosurgery, spine, pediatric neurosurgery, functional neurosurgery, epilepsy, neuro-trauma, and peripheral nerve disease) and laboratory work in neuroscience.
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