Objective

To determine the effect of carotid endarterectomy (CEA) and carotid artery stenting (CAS) on early (baseline vs. maximum three months) and late (baseline vs. at least five months) cognitive function in patients with exclusively asymptomatic carotid stenoses (ACS).

Method

Searches were conducted in PubMed/Medline, Embase, Scopus, and the Cochrane library. This systematic review includes 31 non-randomised studies.

Results

Early post-operative period: In 24 CEA/CAS/CEA+CAS cohorts (n = 2 059), two cohorts (representing 91/2 059, 4.4% of the overall study population) reported significant improvement in cognitive function, while one (28/2 059, 1%) reported significant decline. Three cohorts (250/2 059, 12.5% reported “mixed findings” where some cognitive scores significantly improved, and a similar proportion declined. The majority (nine cohorts; 1 086/2 059, 53%) reported no change. Seven cohorts (250/2 059, 12.1%) were mostly unchanged but one to two individual test scores improved, while two cohorts (347/2 059, 16.8%) were mostly unchanged with one to two individual test scores worse. Late post-operative period: In 21 cohorts (n = 1 554), one (28/1 554, 1.8%) reported significantly worse cognitive function, one reported significant improvement (24/1 554, 1.5%), while a third (19/1 554, 1.2%) reported “mixed findings”. The majority were unchanged (six cohorts; 1 073/1 554, 69%) or mostly unchanged, but with one to two cognitive tests showing significant improvement (11 cohorts; 386/1 554, 24.8%). Overall, there was a similar distribution of findings in small, medium, and large studies, in studies with controls vs. no controls, in studies comparing CEA vs. CAS, and in studies with shorter/longer late follow up.

Conclusion

Notwithstanding accepted limitations regarding heterogeneity within non-randomised studies, CEA/CAS rarely improved overall late cognitive function in ACS patients (< 2%) and the risk of significant cognitive decline was equally low (< 2%). In the long term, the majority were either unchanged (69%) or mostly unchanged with one to two test scores improved (24.8%). Until new research identifies vulnerable ACS subgroups (e.g., impaired cerebral vascular reserve) or provides evidence that silent embolisation from ACS causes cognitive impairment, evidence supporting intervention in ACS patients to prevent/reverse cognitive decline is lacking.

中文翻译：

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编辑推荐——颈动脉干预对无症状颈动脉狭窄患者认知功能的影响：系统评价

客观的

确定颈动脉内膜切除术 (CEA) 和颈动脉支架置入术 (CAS) 对完全无症状颈动脉狭窄 (ACS) 患者早期（基线与最长三个月）和晚期（基线与至少五个月）认知功能的影响.

方法

在 PubMed/Medline、Embase、Scopus 和 Cochrane 图书馆中进行了检索。该系统评价包括 31 项非随机研究。

结果

术后早期：在 24 个 CEA/CAS/CEA+CAS 队列（n  = 2 059）中，两个队列（代表 91/2 059，占整个研究人群的 4.4%）报告认知功能有显着改善，而一个（ 28/2 059, 1%) 报告显着下降。三个队列（250/2 059，12.5% 报告了“混合结果”，其中一些认知评分显着提高，而类似的比例下降。大多数（九个队列；1 086/2 059，53%）报告没有变化。七个队列（ 250/2 059, 12.1%) 大部分没有变化，但一到两个个人测试分数提高，而两个队列 (347/2 059, 16.8%) 大部分没有变化，一到两个个人测试分数变差。术后后期：在 21 个队列中 ( n = 1 554)，一名 (28/1 554, 1.8%) 报告认知功能明显恶化，一名报告显着改善 (24/1 554, 1.5%)，而三分之一 (19/1 554, 1.2%) 报告“混合发现”。大多数没有变化（六个队列；1 073/1 554，69%）或大部分没有变化，但一到两次认知测试显示显着改善（11 个队列；386/1 554，24.8%）。总体而言，在小型、中型和大型研究、有对照与无对照的研究、比较 CEA与CAS 的研究以及较短/较长后期随访的研究中，发现的分布相似。

结论

尽管在非随机研究中存在公认的异质性限制，但 CEA/CAS 很少改善 ACS 患者的整体晚期认知功能（< 2%），并且显着认知下降的风险同样低（< 2%）。从长远来看，大多数人要么没有变化（69%），要么大部分没有变化，一到两次考试成绩提高了（24.8%）。在新的研究确定脆弱的 ACS 亚组（例如，脑血管储备受损）或提供证据表明 ACS 的无声栓塞会导致认知障碍之前，缺乏支持干预 ACS 患者以预防/逆转认知能力下降的证据。