RISK FACTORS FOR COGNITIVE IMPAIRMENT AFTER CAROTID ENDARTERECTOMY

Highlights The effect of carotid endarterectomy on the cognitive status of patients remains controversial, as patients with carotid atherosclerosis suffer from chronic cerebrovascular insufficiency, show risk factors for the progression of the atherosclerosis, and suffer from transient ischemic attacks and ischemic stroke. Abstract Background . Carotid endarterectomy has been performed for more than 65 years to prevent primary and secondary ischemic stroke in patients with stenosis and lesion of brachiocephalic arteries. Numerous studies show that revascularization of the carotid artery not only protects against stroke, but can also lead to changes in cognitive functions. However, the effect of carotid endarterectomy on the cognitive status of patients remains controversial, since patients with carotid atherosclerosis suffer from chronic cerebrovascular insufficiency, transient ischemic attacks and ischemic stroke, therefore, the available data are ambiguous and quite contradictory. Aim . To determine the risk factors for cognitive impairment in patients after carotid endarterectomy within 6-month follow-up. Methods . The study included 110 patients with carotid atherosclerosis who underwent carotid endarterectomy. Upon hospitalization, cognitive status was assessed, echocardiography, lipid profile, matrix metalloproteinase-9 (MMP-9), monocyte chemoattractant protein-1 (MCP-1) were studied, systemic immune-inflammation index (SII), neutrophils to leukocytes ratio (NLR) and platelets to lymphocytes ratio (PLR) were calculated. After 6 months, a group of patients with decreased cognitive function was identified. Results. The results revealed the following factors of cognitive decline: type 2 diabetes mellitus (p < 0.025), a history of cerebrovascular disease (p < 0.006), elevated LDL (p < 0.05). There was an increase in indicators of systemic inflammation and fibrosis in the group with impaired cognitive function: NLR increased by 8.1% (p < 0.05), PLR by 4.5% (p > 0.05), (SII) by 15.8% (p < 0.01), MMP-9 by 51.7% (p < 0.001), and MCP-1 by 21.2% (p < 0.001). After 6 months patients of this group presented with the lower ejection fraction (10.3% decrease (p < 0.01). The average LDL level was 16.7% higher (p < 0.05). Conclusion . Risk factors for cognitive impairment six months after carotid endarterectomy were diabetes mellitus, smoking, uncontrolled arterial hypertension, multifocal atherosclerosis, a history of stroke, dyslipidemia, increased levels of fibrosis markers and indicators of systemic inflammation.