Carotid endarterectomy (CEA) has been associated with both cognitive decline and improvement, but the underlying neurovascular mechanisms are unclear. The aim of this study was to investigate the relationship between neurovascular indices and cognitive changes after CEA. We studied 55 patients with severe (≥70%) symptomatic or asymptomatic carotid stenosis before and six months after CEA. A wide array of neuropsychological tests was arranged in eight cognitive domains and cognitive functions specific to hemisphere ipsilateral to operation. Differences in cognitive performance between patients and 38 matching healthy controls were studied with linear mixed models. Neurovascular functioning and microembolic signals were assessed with transcranial Doppler ultrasound of the middle cerebral artery. Associations between neurovascular indices and cognitive change were assessed with linear regression analyses. On group level, the CEA patients improved more than controls in working memory, whereas no cognitive deterioration was detected. Also on individual level, improvement was most frequently observed in working memory. Worse preoperative cerebrovascular reactivity was related with improvement in cognitive functions of the ipsilateral hemisphere. Low preoperative pulsatility index was associated with improvement in executive functioning and ipsilateral cognitive functions. Poorer preoperative blood flow velocity associated with improvement in complex attention. Microembolic signals were rare. The present findings suggest that CEA may have beneficial long-term effects on cognition. These effects may specifically involve patients with impaired preoperative circulatory adaptive mechanisms.

中文翻译：

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颈动脉内膜切除术后的长期认知和神经血管变化

颈动脉内膜切除术（CEA）与认知能力下降和改善有关，但潜在的神经血管机制尚不清楚。本研究的目的是探讨 CEA 后神经血管指数与认知变化之间的关系。我们研究了 55 名在 CEA 之前和之后 6 个月患有严重（≥70%）有症状或无症状颈动脉狭窄的患者。一系列广泛的神经心理学测试被安排在八个认知领域和特定于手术同侧半球的认知功能。使用线性混合模型研究了患者和 38 名匹配的健康对照之间认知表现的差异。通过大脑中动脉的经颅多普勒超声评估神经血管功能和微栓塞信号。通过线性回归分析评估神经血管指数和认知变化之间的关联。在群体层面上，CEA 患者的工作记忆改善程度高于对照组，但未检测到认知能力恶化。同样在个人层面上，最常见的是工作记忆的改善。术前较差的脑血管反应性与同侧半球认知功能的改善有关。术前低搏动指数与执行功能和同侧认知功能的改善相关。术前血流速度较差与复杂注意力的改善相关。微栓塞信号很少见。目前的研究结果表明，CEA 可能对认知产生有益的长期影响。这些影响可能特别涉及术前循环适应机制受损的患者。