الفهرس 
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Abstract
Summary
Carotid artery stenosis is not only an independent risk factor of ischemic stroke but is also associated with impaired cognitive function. Carotid artery stenting is a safe procedure for management of carotid stenosis. There is a debate about the effect of the filter on preventing or decreasing the distal brain emboliztion. The effect of carotid artery stenting on cognitive function is unclear. Both cognitive improvement and decline have been reported after CAS.
The aim of this study is to analyze the impact of using protection device (filter) during CAS and also the effect of CAS with and without filter on the cognitive function.
The study was performed on 30patients with carotid stenosis, 15 patient treated with CPD (filter) and 15 without. The mean age for patients was 63.33 ± 6.51 years in group I and 60.6 ±11.84 years in group II. There was no statistically significant difference between both groups regarding age, sex, smoking, DM, hypertension or ischemic heart disease.
All included patients were subjected to the following:
● Thorough history taking including: age, gender, education, systemic arterial hypertension, diabetes mellitus, tobacco smoking, and drug abuse
● Neurological assessment: it was done for all patients using National Institutes of Health Stroke Scale (NIHSS) preoperative and one month post-operative
● Cognitive assessment: was done before intervention and one month after intervention using the following psychometric tests: PALT, BVRT, Trail A and B test.
● Lab investigation: CBC, Kidney function tests (bl.urea&s.creatine),coagulation profile (PT,PTT,PC,INR)
● Radiological assessment:
o Doppler ultrasound or CT angiography: to assess severity of carotid stenosis and type of plaque before treatment.
o Brain MRI or CT: to assess brain structure, exclude other intracranial diseases, and obtain information regarding the location, morphology and size of any infarction
o Diffusion MRI: was done within 4 hours before and after CAS to assess newly developed ischemic lesions post intervention.
● Cardiovascular assessment: including echocardiography and ECG.
The results of our study were summarized in the following:
▪ No statically significant difference was found between patients treated with protection device and those who were not treated concerning the occurrence of post intervention new ischemic lesions.
▪ There was a statistically significant improvement in cognitive functions (verbal and visual memory, executive function, attention and psychomotor speed) after CAS whether the filter was used or not.
Conclusion
Using protection device in carotid stenting doesn’t have a statistically significant impact in the improved cognitive function post CAS or reducing the possibility of development of new ischemic lesions.