P-113 - COGNITIVE AND BALANCE IMPROVEMENT AFTER CAROTID ENDARTERECTOMY IN ASYMPTOMATIC PATIENTS: A PROSPECTIVE STUDY

TOPIC:
Other
AUTHORS:
Cruz Silva J. (Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra ~ Coimbra ~ Portugal) , Silva E. (Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra ~ Coimbra ~ Portugal) , Constâncio Oliveira V. (Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra ~ Coimbra ~ Portugal) , Ganacleto G. (Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra ~ Coimbra ~ Portugal) , Fonseca M. (Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra ~ Coimbra ~ Portugal)
Introduction:
Recent studies proved impaired mobility, balance and cognition in patients with significant asymptomatic carotid stenosis (ACAS) in comparison to general community adult population, with higher limitations in patients with severe stenosis. In our study, we tested the hypothesis that patients with severe ACAS (unilateral or bilateral ≥70% diameter-reducing stenosis) will have cognitive and balance improvement after carotid revascularization.
Methods:
All asymptomatic patients who underwent carotid endarterectomy between 2020 and 2021 in our institution were enrolled in the study. Patients with past history of stroke/amaurosis fugax more than 6 months ago with complete clinical recovery were included. Cognitive, mobility and balance tests were performed the week before surgery and were randomized to post-operative re-evaluation at 6-8 months or 12-14 months. Executed tests were Mini-Mental State Exam (MMSE), Timed Up and Go test (TUG), 2 Minute Walk Test (2MWT), Berg Balance Scale (BBS) and Activities-specific Balance Confidence (ABC) Scale. Cognitive defect was considered if MMSE≤22 if ≤2 years education and MMSE≤24 if 3-6 years education. A TUG score of ≥13.5 seconds was used to identify individuals at higher risk of falling. 2MWT was used to calculate gait speed and classified as risk of frailty if <0.8m/s. Impaired balance was diagnosed using 14-item BBS if score <45 or ABC scale <80%. Student's t tests were used to evaluate difference between baseline and post-operative results and McNemar's test to compare frequency of patients with pre-operative and post-operative impairment in each test. Pearson's correlation was used to examine relationship between cognitive and balance change after surgery. A P-value of <.05 was considered as statistical significance.
Results:
18 patients were recruited. The mean age was 70.1±7.3 years. 72.2% were man. 44.4% had severe unilateral stenosis and the remaining had bilateral stenosis. One patient was lost in follow-up. Patients showed reduced scores at baseline, ranging from 11.1% to 38.9% depending on the evaluated test. Also, 44.4% of the patients had MMSE<28 at baseline. Statistical difference was noted between pre and post-operative changes in the majority of the tests (p<.05, except for TUG). Greatest significant improvement was noted in BBS score (38.9% impaired baseline results versus 5.9% after surgery, p=.004) and MMSE score (11.1% cognitive deficit before surgery versus 0% after revascularization, p<.001). After surgery significant improvement in absolute score was noted in overall and impaired patients using balance scale BBS (p=.001) and for patients with baseline cognitive deficit using MMSE (p=.04). Patients with lower baseline balance and cognitive scores had higher improvement after revascularization (r=0.82 for BBS and r=0.87 for MMSE, p<.001). Time of post-operative evaluation did not influence tests scores.
Conclusion:
Carotid endarterectomy improved balance and cognitive scores in asymptomatic patients with severe unilateral or bilateral stenosis. Greatest improvements were noted in patients with most impaired scores at baseline.