Impact of silent ischemic lesions on cognition following carotid artery Stenting

Objective: The occurrence of silent ischemic lesions (SILs) is a common finding after carotid artery stenting (CAS). This study aimed to evaluate the impact of SILs on cognitive functioning following CAS. Methods: The retrospective study separated 131 patients with unilateral carotid stenosis into three groups: medication only, MRI-evaluated CAS and CT-evaluated CAS, and compared the sociodemographic factors, post-CAS images and Mini-Mental State Examination scores performed before and 6-12 months after enrollment. Results: Seven minor strokes occurred in the 99 patients receiving CAS. SILs were detected in 12 of 55 patients with diffusion-weighted MR imaging (DWI) and in 3 of 37 patients with CT 1 week after CAS. In patients with DWI follow-up, the frequency of SILs was 8, 24, 43 and 60% in patients with 0-, 1-, 2- and 3-vessel coronary artery disease (p = 0.006). The frequency of SILs on DWI was 0, 32 and 33% in patients with improved, unchanged, or deteriorated cognitive functioning (p = 0.02). Such an association was not observed if based on SILs on CT or manifesting stroke. Conclusion: The presence of coronary artery disease increases the risk for having post-CAS SILs, and the occurrence of SILs may be associated with cognitive changes after CAS.