Carotid Artery Procedures Do Not Improve Cognitive Performance

Improving humor travel to nan encephalon by opening a narrowed cervix artery whitethorn not amended patients' cognitive skills, according to a preliminary late-breaking subject position astatine nan American Stroke Association's International Stroke Conference 2026. The meeting, Feb. 4 - 6, 2026, successful New Orleans, is simply a world premier gathering for researchers and clinicians dedicated to nan subject of changeable and encephalon health.

Whether patients acquisition a process to region plaque successful nan carotid artery (carotid endarterectomy), stenting to insert a elastic conduit to clasp unfastened nan narrowed portion of nan artery, aliases a operation of medications and manner guidance without a procedure, location should beryllium nary anticipation that cognition will amended aft nan treatment."

Ronald M. Lazar, Ph.D., FAHA, study lead author, professor of neurology and neurobiology astatine nan University of Alabama astatine Birmingham (UAB) and head of nan UAB McKnight Brain Institute

Carotid artery stenosis, a narrowing of nan carotid arteries successful nan neck, is usually owed to plaque buildup. Standard curen involves intensive aesculapian management, including aspirin to forestall humor clots, medicine for precocious humor unit aliases cholesterol, and manner changes specified arsenic smoking cessation, weight nonaccomplishment if needed, accrued beingness activity and a patient diet. In addition, erstwhile nan artery is much than 70% blocked, either carotid endarterectomy aliases stenting whitethorn beryllium recommended.

The CREST-2 (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis) Trial compared changeable rates among group randomly selected to person either intensive aesculapian guidance alone; intensive guidance mixed pinch carotid endarterectomy; aliases intensive guidance positive stenting.

Almost each erstwhile investigation has recovered an relation betwixt carotid stenosis and little capacity connected tests of cognitive function. The CREST-2 substudy included a "cognitive core" constituent to measure cognitive capacity earlier curen and yearly for up to 4 years. This is nan first ample carotid stenosis study to see cognition arsenic a awesome result successful nan study creation of a randomized controlled trial.

"The encephalon needs a dependable travel of humor to get oxygen for its cells. When humor vessels can't present capable blood, nan encephalon doesn't get capable oxygen, and nan neurons can't activity properly, which impacts nan brain's expertise to usability properly. This often leads to changes successful cognitive skills for illustration attention, processing velocity and decision-making skills," Lazar said.

Lazar and coauthors published results successful 2021 successful Stroke, nan peer-reviewed technological diary of nan American Stroke Association, a section of nan American Heart Association. The study showed that, earlier carotid stenosis treatment, 786 patients pinch terrible (over 70% blocked) but symptomless carotid stenosis who entered nan CREST-2 proceedings had little cognitive skills scores — particularly successful representation — compared to participants successful a abstracted population-based study matched for akin demographics and cardiovascular consequence factors.

"The 2021 study indicated that revascularization mightiness amended cognitive function," said Lazar, who is nan main interrogator of nan Cognitive Core substudy and wide co-investigator of CREST-2.

However, pinch an mean of 2.8 years of follow-up aft treatment, nan CREST-2 substudy researchers recovered nary quality successful reasoning aliases representation complete clip among participants who had a process to reconstruct humor travel (stenting aliases surgery) and those treated solely pinch intensive aesculapian therapy. "Even among participants pinch nan lowest cognitive usability astatine nan commencement of nan study, who were expected to summation nan astir from these treatments, location were still nary differences successful cognitive skills among nan curen groups," Lazar said.

Cognitive diminution was confirmed successful nan participants who had a changeable during nan study, validating that nan cognitive tests were capable to observe existent changes successful encephalon and neurological function.

These results whitethorn alteration really wellness attraction professionals counsel patients astir nan benefits of stenting aliases room to unfastened narrowed carotid arteries. "Health attraction professionals tin nary longer asseverate that curen of carotid stenosis will amended cognition. However, worsening cognition complete clip whitethorn beryllium a awesome that curen whitethorn request to beryllium re-evaluated and perchance adjusted," Lazar said.

The study could not find whether reduced humor travel to nan encephalon is nan sole aliases astir important logic for cognitive diminution successful carotid artery disease. "Some characteristics of a blockage tin origin mini particles to recreation to nan brain. These particles may, complete time, impact really nan encephalon functions. This is an area we scheme to research successful our early research," Lazar said.

The study's further limitations see that each cognitive tests were conducted complete nan phone, making it intolerable to trial participants' visuo-spatial skills and nan afloat scope of executive functions, specified arsenic decision-making. Also, only English-speaking patients were included successful nan substudy, so, nan results whitethorn not beryllium generalizable to different populations.

"These results from CREST-2 do not supply grounds of use of carotid revascularization connected cognitive usability among patients pinch important carotid stenosis, though location is simply a use for changeable reduction," said Mitchell Elkind, M.D., M.S., FAHA, FAAN, nan American Heart Association's Chief Science Officer for Brain Health and Stroke and a past unpaid president of nan Association (2020-2021). "Cognitive diminution associated pinch aging is simply a analyzable problem; however, restoration of humor travel done nan ample vessels unsocial whitethorn not beryllium capable to reside nan galore different pathways to decline, specified arsenic inflammation, neurodegeneration and mini alloy disease. More investigation connected really to mitigate cognitive diminution and trim dementia consequence is needed, which is why nan American Heart Association has supported study of these important areas and others."