Elizabeth Hitchner1, Phoebe Liao1, Allyson Rosen1, Barton Lane1, Oliver Aalami2, Wei Zhou2
1Palo Alto Veterans Affairs, Palo Alto, CA; 2Surgery, Stanford University, Stanford, CA.
OBJECTIVES: Carotid interventions have been shown to decrease stroke risk and improve cerebral perfusion. However, nearly 40% of patients who undergo carotid revascularization procedures experience cognitive deterioration. We have demonstrated that subclinical microembolization is associated with memory decline. The role of genetic factors in cognitive function is unclear. We herein seek to assess genetic determinants as potential risk factors for these procedures.
METHODS: Over 1 year period, patients undergoing carotid interventions at a single academic institution were recruited to participate. Patients underwent neuropsychological testing 2 weeks prior to and at 1 month following their procedure and MRI prior to and within 48 hours following their procedure. Saliva samples were collected for genetic testing and demographics were recorded. Logistic regressions were used to search for associations.
RESULTS: Thirty-four patients were included (18 CAS, 16 CEA); all were male with a mean age of 68. The majority of patients exhibit hypertension (94%) and have a history of smoking (76%). Other co-morbidities included diabetes (47%), obesity (35%) and CAD (44%). Consistent with previous findings, CAS was associated with higher incidence of microemboli (p=0.0005) and with susceptibility to memory decline (p=0.0085). Negative univariate associations were found for 5-HTT (serotonin transporter) short alleles with memory decline (p=0.016) and brain-derived neurotrophic factor (BDNF) polymorphism with incidence of microemboli (p=0.018). After adjusting for ApoE risk alleles, incidence of microemboli trended with memory decline (p=0.099).
CONCLUSIONS: Despite a small number of patients, our study showed that genetic polymorphisms such as 5-HTT, BDNF and ApoE may provide additional insight on post-operative changes in cognition. Further investigation of these polymorphisms is warranted to understand and potentially prevent cognitive deterioration following carotid revascularization procedures.
AUTHOR DISCLOSURES: O. Aalami: Nothing to disclose; E. Hitchner: Nothing to disclose; B. Lane: Nothing to disclose; P. Liao: Nothing to disclose; A. Rosen: Nothing to disclose; W. Zhou: Nothing to disclose.
Posted April 2013