Statin Neuroprotection and Carotid Endarterectomy: Safety, Feasibility and Outcomes
The investigators hypothesize that pre-operative statin use is neuroprotective at maximal doses. The goals are to determine the safety, feasibility, and efficacy of maximizing statin doses for two weeks (12-18 days) prior to CEA using change in performance on a battery neuropsychometric tests as outcome measure. Study will recruit patients based on their preexisting statin regimen. The investigators hypothesize that in asymptomatic CEA patients: 1) Pre-operative statin use is neuroprotective against early cognitive dysfunction (eCD) and lowers the risk of early mortality. 2) Maximal doses may be essential in achieving optimal neuroprotection against eCD.
• Age ≥ 18 years of age.
• Patient is currently on atorvastatin or simvastatin or rosuvastatin or statin naïve (no statins in the last 30 days).
• The patient has unilateral or bilateral carotid artery stenosis that is considered severe (carotid artery diameter reduction ≥ 70%) as defined by:
‣ Peak systolic velocity of at least 230 cm/s plus at least one of these:
⁃ End diastolic velocity ≥ 100 cm/s OR
⁃ CTA showing ≥ 70% stenosis OR
⁃ MRA showing ≥ 70% stenosis
• This stenosis has not caused any stroke, transient cerebral ischemia, or other relevant neurological symptoms in the past.
• The patient's attending doctor(s) (PMD, cardiologist, vascular/neurosurgeon) AND the patient have decided to proceed with a CEA to treat the patient's severe carotid stenosis.
• The patient has no known circumstance or condition likely to preclude 1 year follow-up or adherence to the study protocol.
• The patient is independent in their Activities of Daily Living at baseline.
• Patient has the ability to provide informed consent.