Easily Screenable Characteristics Associated with Cognitive Improvement and Dysfunction After Carotid Endarterectomy

The risk factors of postoperative cognitive dysfunction in patients undergoing carotid endarterectomy: an updated meta-analysis

OBJECTIVE

The purpose of the current meta-analysis was to determine the incidence and risk factors to provide a scientific basis for prevention and treatment of postoperative cognitive dysfunction (POCD) after carotid endarterectomy (CEA).

METHODS

Relevant articles published before October 2022 were searched from Pubmed/MEDLINE, Cochrane and Embase databases. The outcomes were the incidence and risk factors for POCD. A random-effects model was applied to estimate the overall odds ratios (ORs) and mean differences (MDs) for all risk factors through STATA 14.0 and RevMan 5.4. The quality of eligible studies was evaluated by Newcastle-Ottawa Scale (NOS) as previously described.

RESULTS

A total of 22 articles involving 3459 CEA patients were finally identified. The weighted mean incidence of POCD was 19% (95% confidence intervals (95% CI) 0.16-0.24, P < 0.001). Of the 16 identified risk factors, hyperperfusion (OR: 0.54, 95% CI 0.41-0.71) and degree of internal carotid artery (ICA) stenosis (OR: 5.06, 95% CI 0.86-9.27) were the potential risk factors of POCD, whereas patients taking statins preoperative had a lower risk of POCD (OR: 0.54, 95% CI 0.41-0.71). Subgroup analysis revealed that the risk of POCD at 1 month after CEA was higher in patients with diabetes (OR: 1.70, 95% CI 1.07-2.71).

CONCLUSION

The risk factors of POCD were hyperperfusion and degree of ICA stenosis, while diabetes could significantly increase the incidence of POCD at 1 month after surgery. Additionally, preoperative statin use could be a protective factor for POCD following CEA.

Utility of sample entropy from intraoperative cerebral NIRS oximetry data in the diagnosis of postoperative cognitive improvement

Background: Appropriate monitoring and early recognition of postoperative cognitive improvement (POCI) are essential. Near-infrared spectroscopy (NIRS) showed the predictive potential of POCI. Non-linear dynamical analysis is a powerful approach for understanding intraoperative regional cerebral oxygen saturation (rSO₂).

Objective: We hypothesized that the sample entropy (SampEn) value of intraoperative rSO₂ has the potential to predict POCI.

Methods: This retrospective cohort study was conducted from June 2019 and December 2020 in a tertiary hospital in Beijing, China. A total of 126 consecutive patients who underwent carotid endarterectomy (CEA) were screened. 57 patients were included in this analysis. The primary outcome was the diagnostic accuracy of rSO₂ for the prediction of POCI.

Results: 33 patients (57.9%) developed POCI on postoperative day. The SampEn values of rSO₂ were significantly higher in the POCI group (p < 0.05). SampEn remained an independent predictor of POCI in multivariate analysis. The area under the ROC curve (AUC) value of SampEn of rSO₂ for POCI were 0.706 (95% CI, 0.569–0.843; p = 0.008). Addition of preoperative MoCA assessment and blood pressure-lowering treatment increased the AUC to 0.808 (95% CI, 0.697–0.919; p < 0.001).

Conclusions: The SampEn value of rSO₂ showed promise as a predictor of POCI. Non-linear analysis could be used as a supplementary method for intraoperative physiological signals.

Carotid endarterectomy restores decreased vision due to chronic ocular ischemia

BACKGROUND

The therapeutic effect of carotid endarterectomy (CEA) on visual disturbance caused by chronic ocular ischemia due to carotid artery stenosis has not been validated. This prospective observational study aims to investigate whether CEA is associated with an increase in ocular blood flow (OBF) and postoperative visual improvement.

METHODS

In total, 41 patients with carotid artery stenosis treated by CEA between March 2015 and September 2018 were enrolled in this study. OBF was evaluated by laser speckle flowgraphy, which can measure the mean blur ratio (MBR) which is well correlated to the absolute retinal blood flow. Visual acuity was assessed before and after CEA by subjective improvement and objective visual assessment using CSV-1000, an instrument used to test contrast sensitivity.

RESULTS

OBF increased after CEA on the operated side (mean MBR 33.5 vs 38.2, p < 0.001) but not on the non-operated side (mean MBR 37.8 vs 37.5, p = 0.50). After CEA, 23 patients (56.1%) reported subjective visual improvement on the operated side. The mean CSV-1000 score among the patients with increased OBF after CEA (5.44 vs 5.88, p = 0.04) but not among those without increased OBF (5.48 vs 5.95, p = 0.09). The mean CSV-1000 scores increased significantly after CEA in 18 patients with decreased vision and decreased OBF (4.51 vs 5.37, p < 0.001), but not in the 23 patients without those (6.19 vs 6.31, p = 0.6).

CONCLUSION

CEA may successfully reverse visual dysfunction caused by chronic ocular ischemia due to carotid artery stenosis by increasing OBF.