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Systemic Biomarkers Predict Cognitive Decline Following Carotid Revascularization - A Prospective Study
Thuy Tran*1, Gayatri Raghuraman*2, Mary Zuniga*3, Elizabeth Hitchner*3, Allyson Rosen*2, Wei Zhou1
1Stanford University, Palo Alto, CA;2VA Palo Alto Health Care System, Palo Alto, CA;3VA palo Alto Health Care System, Palo Alto, CA

Objectives: Cognitive impairment is common in elderly patients with carotid occlusive diseases. The objective of this study is to determine factors affecting cognition and identify predictors of long-term cognitive impairment.
Methods: Patients undergoing carotid intervention for severe occlusive diseases were prospectively recruited. Patients received neurocognitive testing prior to, 1-, 6-, and 12- months after carotid interventions. Plasma samples were also collected within 48 hours after carotid intervention and inflammatory cytokines were analyzed. Univariate and multivariate logistic regressions were performed to identify risk factors associated with significant cognitive deterioration (> 10% decline).
Results: A total of 98 patients (48% symptomatic) were recruited. Mean age was 69 (range 54-91 years). Patients had overall improvement in cognitive measures one month after revascularization. When compared to carotid stenting (n=55), endarterectomy patients (n=43) demonstrated postoperative improvement in cognition at 1 month and 6 months compared to baseline. Carotid stenting (OR 6.49, p=0.020) and age greater than 80 years (OR 12.6, p=0.023) were associated with significant short and long-term cognitive impairment. Multiple inflammatory cytokines also showed significant changes after revascularization. On multivariate analysis after controlling for procedure and age, IL12P40 (p=0.041) was associated with a higher risk of significant cognitive impairment at one month; SDF1a (p=0.004) and TNFa (p=0.006) were independent predictors of cognitive impairment, while IL6 (p=0.019) demonstrated cognitive protective effects at 6 months after revascularization.
Conclusion: Carotid intervention affects cognitive function. Systemic biomarkers can be used to identify patients at risk of significant cognitive decline post-procedures that benefit from targeted cognitive training.


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