Early Cognitive Outcomes After Carotid Endarterectomy in Asymptomatic Stenosis: A Pilot Study
Bibliographic record
Abstract
Background Perioperative neurocognitive disorders (PNDs) are important determinants of postoperative quality of life. Evidence on early cognitive outcomes after carotid endarterectomy (CEA) in neurologically intact, asymptomatic patients remains limited, and reported incidences vary widely. Methodology This single-center prospective observational pilot study (ClinicalTrials.gov NCT06391866) enrolled 18 statin-treated adults (mean age 78.3 ± 4.9 years) with asymptomatic ≥70% ICA stenosis undergoing CEA under balanced general anesthesia with bilateral near-infrared spectroscopy (NIRS) and entropy monitoring. Neurological (National Institutes of Health Stroke Scale (NIHSS)) and Montreal Cognitive Assessment (MoCA) tests were done preoperatively and 24 hours postoperatively; patients with delirium were excluded. Subjective cognitive change was assessed at 30 days by interview. Early POCD was a ≥2-point MoCA decline. Results Mean clamp time was 29.1 ± 6.4 minutes; no shunts were used. NIRS showed no ≥25% decrease or >10% increase from baseline after unclamping. NIHSS was unchanged (median 1 → 1, p > 0.05). MoCA fell non-significantly from 30.0 ± 1.8 to 29.6 ± 2.3 (p > 0.05); one patient (5.6%) met criteria for early POCD. At 30 days, one patient reported improvement, 13 had no change, three were lost to follow-up, and one died of non-neurological causes. No strokes, transient ischemic attacks (TIAs), or hyperperfusion occurred. Conclusions In this small pilot study of neurologically intact, asymptomatic patients undergoing CEA with meticulous monitoring, early postoperative cognitive decline was rare, neurological function remained stable, and no major perioperative complications occurred. These findings suggest that with careful intraoperative management, CEA is generally safe regarding early cognitive outcomes in this population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".