Carotid endarterectomy (CEA) is extremely efficacious in preventing stroke- and reducing death due to the low incidence of major surgical complications (2-5 percent incidence of stroke). However, at least 30 percent of endarterectomy patients experience cognitive deficits, revealed by a battery of neuropsychometric tests (NPMTs). Although most strokes after CEA are due to FOCAL injury from emboli coming from the surgical field, we hypothesize that some patients without EEG evidence of cerebral ischemia may still have GLOBAL ischemia as indicated by TCD that leads to cognitive deficits and decreases quality of life. We further hypothesize that the incidence and severity of cognitive deficits will be significantly reduced in these patients if CBF is augmented by placement of a shunt across the operative site.
Specific Aims : In order to test thehypotheses we propose the following: 1. To demonstrate that a certain percentage of patients with normal EEGs develop significant cognitive deficits due to GLOBAL brain parenchymal damage after CEA by three independent measures of cerebralinjury ury:functional, structural and biochemical 2. To determine prospectively the importance of GLOBAL hypoperfusion by randomizing patients who have normal EEGs but significantly teduced CBF velocity after carotid artery clamping into two groups. One group will have a shunt inserted across the operative site and the other, not (the current standard). Each will be assessed for cognitive deficits, and structural and biochemical changes. Conclusion: We shall demonstrate that cognitive deficits arise from GLOBAL ischemia when the carotid artery is clamped, which can be assessed by TCD ultrasonography and prevented by increasing cerebral perfusion using a shunt across the surgical site. EEG is inadequate to determine this subtle degree of hypoperfusion.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG017604-03
Application #
6644751
Study Section
Special Emphasis Panel (ZRG1-BDCN-6 (01))
Program Officer
Wagster, Molly V
Project Start
2001-09-15
Project End
2005-08-31
Budget Start
2003-09-01
Budget End
2004-08-31
Support Year
3
Fiscal Year
2003
Total Cost
$388,313
Indirect Cost
Name
Columbia University (N.Y.)
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
Heyer, Eric J; Mallon, Kaitlin A; Mergeche, Joanna L et al. (2015) Deficits of hand coordination and laterality of carotid endarterectomy. J Neurosurg 122:101-6
Heyer, Eric J; Mergeche, Joanna L; Wang, Shuang et al. (2015) Impact of Cognitive Dysfunction on Survival in Patients With and Without Statin Use Following Carotid Endarterectomy. Neurosurgery 77:880-7
Anastasian, Zirka H; Gaudet, John G; Levitt, Laura C et al. (2014) Factors that correlate with the decision to delay extubation after multilevel prone spine surgery. J Neurosurg Anesthesiol 26:167-71
Mergeche, Joanna L; Bruce, Samuel S; Sander Connolly, E et al. (2014) Reduced middle cerebral artery velocity during cross-clamp predicts cognitive dysfunction after carotid endarterectomy. J Clin Neurosci 21:406-11
Gressot, Loyola V; Chamoun, Roukoz B; Patel, Akash J et al. (2014) Predictors of outcome in civilians with gunshot wounds to the head upon presentation. J Neurosurg 121:645-52
Sussman, Eric S; Kellner, Christopher P; Mergeche, Joanna L et al. (2014) Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy. J Neurosurg 121:593-8
Heyer, Eric J; Mergeche, Joanna L; Connolly Jr, E Sander (2014) Middle cerebral artery pulsatility index and cognitive improvement after carotid endarterectomy for symptomatic stenosis. J Neurosurg 120:126-31
Heyer, Eric J; Mergeche, Joanna L; Anastasian, Zirka H et al. (2014) Arterial blood pressure management during carotid endarterectomy and early cognitive dysfunction. Neurosurgery 74:245-51; discussion 251-3
Heyer, Eric J; Mergeche, Joanna L; Stern, Yaakov et al. (2014) Apolipoprotein E-?4 polymorphism and cognitive dysfunction after carotid endarterectomy. J Clin Neurosci 21:236-40
Anastasian, Zirka H; Khan, Nayema; Heyer, Eric J et al. (2014) Effect of atropine dose on heart rate during electroconvulsive therapy. J ECT 30:298-302

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