Henry Ford Hospital Medical Journal


Mark P. Kelly


We reviewed the recent literature on the relationship between carotid artery disease, carotid endarterectomy, and behavior. The methodological adequacy of each study and the complexities involved in interpreting behavioral changes in patients with carotid disease are emphasized. Experimental design issues qualify conclusions in all studies. The weight of the evidence suggests that carotid artery disease may result in cognitive impairment, and that carotid endarterectomy is followed by psychometrically determined cognitive improvement in some patients. Although characteristics of the subgroup of patients most likely to improve have been identified in preliminary investigations, the clinical significance of such improvement has not been systematically evaluated. At present, evidence is insufficient to suggest that impaired cognition should serve as an indication for surgery. Carotid endarterectomy is performed to prevent cerebrovascular episodes, and postoperative neurobehavioral improvement should be viewed as a possible additional benefit.



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