학술논문
Is Hemispheric Hypoperfusion a Treatable Cause of Cognitive Impairment?
Document Type
Academic Journal
Author
Norling AM; Department of Neurology, University of Alabama at Birmingham, 1720 7th Ave S-SC 650, Birmingham, AL, 35294, USA.; Marshall RS; Department of Neurology, Columbia University Medical Center, New York, NY, USA.; Pavol MA; Department of Neurology, Columbia University Medical Center, New York, NY, USA.; Howard G; Department of Biostatistics (GH), University of Alabama at Birmingham, Birmingham, AL, USA.; Howard V; Department of Epidemiology (VH), University of Alabama at Birmingham, Birmingham, AL, USA.; Liebeskind D; Department of Neurology, University of California, Los Angeles, CA, USA.; Huston J 3rd; Department of Neuroradiology (JH), Mayo Clinic, Rochester, MN, USA.; Lal BK; Department of Vascular Surgery (BKL), University of Maryland, Baltimore, MD, USA.; Brott TG; Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.; Lazar RM; Department of Neurology, University of Alabama at Birmingham, 1720 7th Ave S-SC 650, Birmingham, AL, 35294, USA. rlazar@uabmc.edu.
Source
Publisher: Current Science Country of Publication: United States NLM ID: 100888969 Publication Model: Electronic Cited Medium: Internet ISSN: 1534-3170 (Electronic) Linking ISSN: 15233782 NLM ISO Abbreviation: Curr Cardiol Rep Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose of Review: To review the current literature that supports the notion that cerebral hemodynamic compromise from internal carotid artery stenosis may be a cause of vascular cognitive impairment that is amenable to treatment by revascularization.
Recent Findings: Converging evidence suggests that successful carotid endarterectomy and carotid artery stenting are associated with reversal of cognitive decline in many patients with severe but asymptomatic carotid artery stenosis. Most of these findings have been derived from cohort studies and comparisons with either normal or surgical controls. Failure to find treatment benefit in a number of studies appears to have been the result of patient heterogeneity or confounding from concomitant conditions independently associated with cognitive decline, such as heart failure and other cardiovascular risk factors, or failure to establish pre-procedure hemodynamic failure. Patients with severe carotid artery stenosis causing cerebral hemodynamic impairment may have a reversible cause of cognitive decline. None of the prior studies, however, were done in the context of a randomized clinical trial with large numbers of participants. The ongoing CREST-2 trial comparing revascularization with medical therapy versus medical therapy alone, and its associated CREST-H study determining whether cognitive decline is reversible among those with hemodynamic compromise may address this question.
Recent Findings: Converging evidence suggests that successful carotid endarterectomy and carotid artery stenting are associated with reversal of cognitive decline in many patients with severe but asymptomatic carotid artery stenosis. Most of these findings have been derived from cohort studies and comparisons with either normal or surgical controls. Failure to find treatment benefit in a number of studies appears to have been the result of patient heterogeneity or confounding from concomitant conditions independently associated with cognitive decline, such as heart failure and other cardiovascular risk factors, or failure to establish pre-procedure hemodynamic failure. Patients with severe carotid artery stenosis causing cerebral hemodynamic impairment may have a reversible cause of cognitive decline. None of the prior studies, however, were done in the context of a randomized clinical trial with large numbers of participants. The ongoing CREST-2 trial comparing revascularization with medical therapy versus medical therapy alone, and its associated CREST-H study determining whether cognitive decline is reversible among those with hemodynamic compromise may address this question.