Early Cognitive Outcomes After Carotid Endarterectomy in Asymptomatic Stenosis: A Pilot Study

Background Perioperative neurocognitive disorders (PNDs) are important determinants of postoperative quality of life. Evidence on early cognitive outcomes after carotid endarterectomy (CEA) in neurologically intact, asymptomatic patients remains limited, and reported incidences vary widely. Methodology This single-center prospective observational pilot study (ClinicalTrials.gov NCT06391866) enrolled 18 statin-treated adults (mean age 78.3 ± 4.9 years) with asymptomatic ≥70% ICA stenosis undergoing CEA under balanced general anesthesia with bilateral near-infrared spectroscopy (NIRS) and entropy monitoring. Neurological (National Institutes of Health Stroke Scale (NIHSS)) and Montreal Cognitive Assessment (MoCA) tests were done preoperatively and 24 hours postoperatively; patients with delirium were excluded. Subjective cognitive change was assessed at 30 days by interview. Early POCD was a ≥2-point MoCA decline. Results Mean clamp time was 29.1 ± 6.4 minutes; no shunts were used. NIRS showed no ≥25% decrease or >10% increase from baseline after unclamping. NIHSS was unchanged (median 1 → 1, p > 0.05). MoCA fell non-significantly from 30.0 ± 1.8 to 29.6 ± 2.3 (p > 0.05); one patient (5.6%) met criteria for early POCD. At 30 days, one patient reported improvement, 13 had no change, three were lost to follow-up, and one died of non-neurological causes. No strokes, transient ischemic attacks (TIAs), or hyperperfusion occurred. Conclusions In this small pilot study of neurologically intact, asymptomatic patients undergoing CEA with meticulous monitoring, early postoperative cognitive decline was rare, neurological function remained stable, and no major perioperative complications occurred. These findings suggest that with careful intraoperative management, CEA is generally safe regarding early cognitive outcomes in this population.