Vascular surgical society of great britain and ireland: impact of spontaneous embolization on cognitive function.

Lloyd, AJ; Smith, JL; Loftus, IM; Hayes, P; Bell, PR; Naylor, AR · Br J Surg · 1999

case_control · Level III

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Abstract

BACKGROUND: Although microembolization may not be associated with focal neurological events following carotid endarterectomy (CEA), it might contribute towards cognitive impairment. METHODS: Forty-nine patients undergoing CEA underwent 30 min of preoperative ipsilateral transcranial Doppler (TCD) monitoring and a battery of tests of cognitive function, and the results were compared with those of age-matched normal controls. RESULTS: Seven patients who were spontaneously embolizing had significantly worse preoperative cognitive function scores than 42 patients with no recorded emboli (P = 0.03). Overall, patients undergoing CEA had a significant cognitive deficit compared with age-matched normal controls. CONCLUSION: Patients who have evidence of spontaneous preoperative embolization on TCD monitoring have a greater degree of preoperative cognitive impairment. This finding underlines the potential clinical importance of microembolization and suggests that this phenomenon should be investigated further.