NEUROPSYCHOMETRIC CHANGES IN PATIENTS AFTER CAROTID ENDARTERECTOMY

Background and Purpose-One hundred twelve patients undergoing elective carotid endarterectomy for symptomatic and asymptomatic carotid arter y stenosis were enrolled in a prospective study to evaluate the incide nce of change in postoperative cerebral function. Methods-Patients wer e evaluated preoperatively and postoperatively before hospital dischar ge and at follow-up 1 and 5 months later with a battery of neuropsycho metric tests. The results were analyzed by both event-rate and group-r ate analyses. For event-rate analysis, change was defined as either a decline or improvement in postoperative neuropsychometric performance by 25% or more compared with a preoperative baseline. Results-Approxim ately 80% of patients showed decline in one or more test scores, and 6 0% had one or more improved test scores at the first follow-up examina tion. The percentage of declined test scores decreased and the percent age of improved test scores increased with subsequent follow-up examin ations. Group-rate analysis was similar for group performance on indiv idual tests. However, a decline in performance was seen most commonly on verbal memory tests, and improved performance was seen most commonl y on executive and motor tests. Conclusions-Neuropsychometric evaluati on of patients undergoing carotid endarterectomy for significant carot id artery stenosis demonstrates both declines and improvements in neur opsychometric performance. The test changes that showed decreased perf ormance may be associated with ischemia from global hypoperfusion or e mbolic phenomena, and the improvement seen may be related to increased cerebral blood flow from removal of stenosis.