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(Stroke. 2006;37:240.)
© 2006 American Heart Association, Inc.

Research Reports

Elevations in Preoperative Monocyte Count Predispose to Acute Neurocognitive Decline After Carotid Endarterectomy for Asymptomatic Carotid Artery Stenosis

J. Mocco, MD; David A. Wilson, BS; Andrew F. Ducruet, MD; Ricardo J. Komotar, MD; William J. Mack, MD; Joseph Zurica, BA; Robert R. Sciacca, EngScD; Eric J. Heyer, MD, PhD E. Sander Connolly, MD

From the Departments of Neurosurgery (J.M., D.A.W., A.F.D., R.J.K., W.J.M., E.S.C.) and Anesthesiology (J.Z., R.R.S., E.J.H.), Columbia University, New York, NY.

Reprint requests to J. Mocco, MD, Columbia University, 710 W 168th St, New York, NY 10032. E-mail jdm32{at}columbia.edu

Background and Purpose— Although the incidence of major stroke attributable to carotid endarterectomy (CEA) is low (1% to 2%), 25% of patients experience subtle postoperative neurocognitive dysfunction. This study examines whether preoperative leukocyte profiles predict cognitive outcome in asymptomatic CEA patients.

Methods— Sixty-nine asymptomatic CEA patients underwent neuropsychometric testing preoperatively and on postoperative day 1 (POD1). Preoperative white blood cell counts and differentials were obtained. Logistic regression was performed for risk factors for neurocognitive decline. Variables achieving univariate P<0.10 were included in multivariate analysis.

Results— Eighteen (26%) patients experienced neurocognitive decline on POD1; multivariate analysis demonstrated that preoperative monocyte count (P=0.011) and age (P=0.02) independently predicted outcome.

Conclusions— Preoperative monocyte count and age are independently associated with acute neurocognitive decline after CEA for asymptomatic stenosis.

Key Words: carotid endarterectomy • ischemia • neuropsychology