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

BACKGROUND AND PURPOSE: Although the incidence of major stroke attributable to carotid endarterectomy (CEA) is low (1% to 2%), approximately 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.