Abstract WMP78: Predictors Of Memory And Carotid Intervention-related Memory Changes

Introduction: Carotid atherosclerosis is the culprit of stroke and dementia. It has been linked to cognitive impairment in cerebrovascular diseases . A bulk of evidence suggests that carotid interventions improve cognitive functions in appropriately selected patients. We aim to investigate the factors that modulate changes in episodic memory following carotid recanalization procedures. Methods: A total of 170 subjects undergoing carotid revascularization procedures were recruited prospectively. Neuropsychometric testing was performed preoperatively, and at 1-,6-, and 12-month postoperatively. Rey Auditory Verbal Learning Test (RAVLT) was used to assess episodic memory. Changes in RAVLT sum scores at individual time points were compared to the baseline. Linear and logistic regression models were fitted to predict RAVLT sum baseline score, and postop changes at each time point compared to preop, respectively. Univariate and multivariate analyses (after adjusting for risk factors and patient demographics) were performed and variables with p <0.25 were included in the multivariable analysis. Results: At baseline, having a prior stroke, and being older than 80 years of age were independent predictors of a low preop RAVLT sum score (p=0.001 and p=0.001 respectively). Interestingly, a low preop RAVLT sum score is the only independent predictor of post-intervention cognitive improvement at all three time points compared to preop (P<0.01). CEA and Age <80 years predicted short-term improvement at 1 and 6 months postop. Conversely, carotid artery stenting (CAS) is an independent predictor of verbal memory decline at 1-month post-intervention (p=0.039), while being older than 80 years of age predicted the decline at 1-month (p= 0.046) and 6-month (p= 0.043) postoperatively. Conclusion: Younger patients with severe atherosclerotic carotid disease and low baseline episodic memory scores benefit most from carotid intervention, specifically CEA, whereas age ≥80 years predicts poor baseline memory score and worse intervention-related memory change. Further studies with larger sample sizes are necessary to confirm the characteristics of patients with carotid occlusive disease who could benefit from revascularization procedures.