# Asymptomatic Carotid Stenosis: Cognitive Function and Plaque Correlates - 2

> **NIH VA I01** · BALTIMORE VA MEDICAL CENTER · 2021 · —

## Abstract

Vascular cognitive impairment is an insidious disease resulting from accumulated ischemic injury to the
brain. Our VA Merit-funded Asymptomatic Carotid Stenosis and Cognitive Function (ACCOF) found that in the
setting of carotid stenosis, alterations of behavior can occur in the absence of physical manifestations of
stroke. Otherwise asymptomatic patients with carotid stenosis had worse cognitive performance than controls.
In addition, approximately 40% of patients with stenosis had cerebral hemodynamic compromise at baseline;
and hemodynamic compromise correlated with cognitive impairment. Not all patients with carotid stenosis have
reduced cerebral perfusion. The geometry of the plaque (degree of stenosis, length and shape of the plaque)
and, as we have demonstrated, the extent of intra-cerebral collateralization across the Circle of Willis, influence
cerebral perfusion.
 The implication of these findings is that a subset of carotid stenosis patients has hemodynamic
compromise, and that reversal of the hemodynamic abnormalities by removing the stenosis may
ameliorate the associated cognitive impairment. Therefore, treatment for carotid stenosis might need to be
broadened to include preservation of cognition-related Quality of Life (QoL). The demonstration that some
patients with carotid stenosis are living with reversible cognitive impairment would have important public-health
implications. Carotid stenosis affects 2-12% of people. With 23 million Veterans in the country, approximately
1 million (4.3%) will have a stenosis. ACCOF shows that these patients are at risk for cognitive impairment
which, with intervention, might be reversible.
 We propose a longitudinal controlled observational study that assesses whether carotid revascularization
improves cognitive dysfunction in patients with cerebral hemodynamic compromise. Proof of concept (followed
by a clinical trial) is necessary before a shift in clinical practice is considered. If cognitive decline can be
reversed in these patients, we will have established a new indication for carotid revascularization independent
of stroke prevention. We will enroll 138 patients with asymptomatic high-grade (≥70%) carotid stenosis
undergoing planned carotid endarterectomy. Approximately 40% (n=55 patients) of patients are anticipated to
have compromised cerebral perfusion at baseline (study group); the remaining 60% (n=83) will have carotid
stenosis but will not have compromised perfusion (control group).
 Our Primary Aim will determine if carotid revascularization improves cognitive performance at 1 year in
patients with cerebral hemodynamic compromise at baseline. We hypothesize that among patients with
asymptomatic carotid stenosis undergoing carotid endarterectomy, cognitive performance will improve more in
those with impaired cerebral perfusion at baseline versus those with normal baseline perfusion. Our
Secondary Aim 1 will determine whether cerebral hemodynamic compromise is the result of pressure d...

## Key facts

- **NIH application ID:** 9932930
- **Project number:** 5I01CX001621-04
- **Recipient organization:** BALTIMORE VA MEDICAL CENTER
- **Principal Investigator:** Brajesh K Lal
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-07-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9932930

## Citation

> US National Institutes of Health, RePORTER application 9932930, Asymptomatic Carotid Stenosis: Cognitive Function and Plaque Correlates - 2 (5I01CX001621-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9932930. Licensed CC0.

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