Neurocognitive changes after carotid revascularization: A review of the current literature

ObjectiveThe objective of this study was to review the current literature evaluating the effect of carotid revascularization on neurocognitive function.MethodsA PubMed search was performed using the following keywords: carotid surgery, carotid stenosis, cognition, and cognition disorders. Bibliographies were cross referenced and related-articles searches were performed once an article of interest had been identified.ResultsTwenty-two studies have been identified from the literature since 1998. Seventeen articles evaluated carotid endarterectomy (CEA), four evaluated carotid stenting, and one compared CEA to stenting. Eight studies found improvements in mood and/or cognition after revascularization, 11 studies showed mixed results, and 3 studies found declines.ConclusionsThere is no consensus within the current literature as to the effect of carotid revascularization on neurocognitive function. Further research—with attention to laterality of neurocognitive effects, patients' symptomatology at the time of presentation, the role of perioperative embolization, and trial design including adequate control groups and comparison between open surgery and stenting factors—is necessary in order to clarify the effects of carotid revascularization on cognition.