PMID- 36905664 OWN - NLM STAT- MEDLINE DCOM- 20231003 LR - 20231003 IS - 1933-0693 (Electronic) IS - 0022-3085 (Linking) VI - 139 IP - 4 DP - 2023 Oct 1 TI - Effects of carotid revascularization on cognitive function and brain functional connectivity in carotid stenosis patients with cognitive impairment: a pilot study. PG - 1010-1017 LID - 10.3171/2023.1.JNS222804 [doi] AB - OBJECTIVE: Carotid stenosis can lead to both cognitive impairment (CI) and ischemic stroke. Although carotid revascularization surgery, which includes carotid endarterectomy (CEA) and carotid artery stenting (CAS), can prevent future strokes, its effect on cognitive function is controversial. In this study, the authors examined resting-state functional connectivity (FC) in carotid stenosis patients with CI undergoing revascularization surgery, with a particular focus on the default mode network (DMN). METHODS: Twenty-seven patients with carotid stenosis who were scheduled to undergo CEA or CAS between April 2016 and December 2020 were prospectively enrolled. A cognitive assessment, including the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Japanese version of the Montreal Cognitive Assessment (MoCA), as well as resting-state functional MRI, was performed 1 week preoperatively and 3 months postoperatively. For FC analysis, a seed was placed in the region associated with the DMN. The patients were divided into two groups according to the preoperative MoCA score: a normal cognition (NC) group (MoCA score >/= 26) and a CI group (MoCA score < 26). The difference in cognitive function and FC between the NC and CI groups was investigated first, and then the change in cognitive function and FC after carotid revascularization was investigated in the CI group. RESULTS: There were 11 and 16 patients in the NC and CI groups, respectively. The FC of the medial prefrontal cortex with the precuneus and that of the left lateral parietal cortex (LLP) with the right cerebellum were significantly lower in the CI group than in the NC group. In the CI group, significant improvements were found in MMSE (25.3 vs 26.8, p = 0.02), FAB (14.4 vs 15.6, p = 0.01), and MoCA scores (20.1 vs 23.9, p = 0.0001) after revascularization surgery. Significantly increased FC of the LLP with the right intracalcarine cortex, right lingual gyrus, and precuneus was observed after carotid revascularization. In addition, there was a significant positive correlation between the increased FC of the LLP with the precuneus and improvement in the MoCA score after carotid revascularization. CONCLUSIONS: These findings suggest that carotid revascularization, including CEA and CAS, might improve cognitive function based on brain FC in the DMN in carotid stenosis patients with CI. FAU - Kohta, Masaaki AU - Kohta M AD - Departments of1Neurosurgery and. FAU - Oshiro, Yoshitetsu AU - Oshiro Y AD - 2Anesthesiology, Kobe University Graduate School of Medicine, Kobe, Japan. FAU - Yamaguchi, Yoji AU - Yamaguchi Y AD - Departments of1Neurosurgery and. FAU - Ikeuchi, Yusuke AU - Ikeuchi Y AD - Departments of1Neurosurgery and. FAU - Fujita, Atsushi AU - Fujita A AD - Departments of1Neurosurgery and. FAU - Hosoda, Kohkichi AU - Hosoda K AD - Departments of1Neurosurgery and. FAU - Tanaka, Kazuhiro AU - Tanaka K AD - Departments of1Neurosurgery and. FAU - Mizobuchi, Satoshi AU - Mizobuchi S AD - 2Anesthesiology, Kobe University Graduate School of Medicine, Kobe, Japan. FAU - Kohmura, Eiji AU - Kohmura E AD - Departments of1Neurosurgery and. FAU - Sasayama, Takashi AU - Sasayama T AD - Departments of1Neurosurgery and. LA - eng PT - Journal Article DEP - 20230310 PL - United States TA - J Neurosurg JT - Journal of neurosurgery JID - 0253357 SB - IM MH - Humans MH - *Carotid Stenosis/complications/diagnostic imaging/surgery MH - Pilot Projects MH - Neuropsychological Tests MH - Stents MH - Brain/diagnostic imaging/surgery MH - Cognition MH - *Endarterectomy, Carotid MH - *Cognitive Dysfunction/diagnostic imaging/etiology/surgery MH - Carotid Arteries OTO - NOTNLM OT - carotid stenosis OT - cognitive impairment OT - default mode network OT - vascular disorders EDAT- 2023/03/12 06:00 MHDA- 2023/10/03 06:47 CRDT- 2023/03/11 15:12 PHST- 2022/12/12 00:00 [received] PHST- 2023/01/26 00:00 [accepted] PHST- 2023/10/03 06:47 [medline] PHST- 2023/03/12 06:00 [pubmed] PHST- 2023/03/11 15:12 [entrez] AID - 10.3171/2023.1.JNS222804 [doi] PST - epublish SO - J Neurosurg. 2023 Mar 10;139(4):1010-1017. doi: 10.3171/2023.1.JNS222804. Print 2023 Oct 1.