Carotid atherosclerosis is a pathological process that leads to narrowing of the vessel lumen and a consequent risk of
stroke. Revascularization procedures such as
carotid endarterectomy (CEA) and carotid stenting aim to reduce occurrence of
stroke in selected patients. Due to the proven benefit and low intraoperative risk, CEA is currently the preferred choice in candidates for carotid revascularization. However, the risk of
cognitive impairment subsequent to CEA has not been fully elucidated and is unclear whether certain conditions, such as
frailty, may increase this risk. There is consistent evidence that shows that frail patients have higher risk of
cognitive impairment after
surgical procedure. Moreover, brain pre-existing conditions may play a role in
cognitive impairment after CEA.
Cerebral small vessel disease (SVD) is a pathology that involves microcirculation and is detectable with computed tomography or magnetic resonance. SVD shares common vascular risk factors with
carotid atherosclerosis, is a major contributor to vascular
cognitive impairment and
vascular dementia, and has been proposed as a marker of brain
frailty. In this review, we discuss the current evidence about the link between carotid revascularization and
cognitive impairment and advance the hypothesis that SVD may play a relevant role in development of
cognitive impairment after carotid revascularization.