Neurocognitive function often improves after carotid stenting
NEW YORK (Reuters Health) - Minimally invasive angioplasty and stenting of carotid stenosis, even among patients who classified as "asymptomatic," often improves their neurocognitive function, according to a presentation this week at the International Symposium on Endovascular Therapy in Hollywood, Florida.
"After performing carotid stenting with distal protection, we've found that nearly half of patients experience long-term, statistically significant improvements in memory, judgment, and reasoning," presenter Dr. Rodney Raabe told Reuters Health. Raabe is chief of radiology at Sacred Heart Medical Center in Spokane, Wash.
"We've had some patients that were able to leave the nursing home and be taken care of at home," he continued, "and some that were able to resume driving. We've even seen patients who previously were unable to work who have now returned to their jobs."
Based on these results, Raabe said, "I challenge that our definition of 'symptomatic' needs to be changed."
Carotid stenosis is considered symptomatic only if the patient has experienced a stroke, a transient ischemic attack, or amaurosis fugax. "But if people's ability to think improves after having their carotid stenosis treated, then they were not asymptomatic to begin with."
His group's study was originally intended to evaluate outcomes of carotid angioplasty and stenting with distal cerebral protection, specifically to see if neurocognitive deficits would result from distal embolization of plaque fragments to the brain.
"Our hypothesis was that any particles that made their way past the filter-like distal protection device would be so small and so few that there would be no decline in thinking, as is often seen in heart patients after surgery," Raabe explained.
The 62 patients had 70% to 80% stenosis, and about half were considered symptomatic. Cognitive function was gauged at baseline and at 3, 6, and 12 months post-procedure.
So far, 37 patients have been followed for 1 year. Overall, Raabe noted, the group showed significant improvements in memory and executive function.
"About 43% show significant improvements in responses on the Dementia Rating Scale II, while the others have also gotten better, but not statistically significantly better," the radiologist said. Only one patient's cognitive function has declined.
He hopes that, once these results are confirmed by larger studies, Medicare will reverse its decision to reimburse for carotid stenting only when patients show signs of impending stroke.