Carotid Stenting Relieves 'Vascular Depression'

VIENNA, July 25 -- Carotid stenting can significantly ease both the frequency and severity of so-called "vascular depression," according to investigators here.

Both frequency and severity" fell sharply in patients who underwent successful carotid stenting for a luminal narrowing of at least 80%, according to Wolfgang Mlekusch, M.D., of Vienna General Hospital and Medical School here.

At the same time, neither frequency nor severity of depression changed in patients who had advanced peripheral artery disease but not carotid stenosis who underwent a lower-limb percutaneous transluminal angioplasty, Dr. Mlekusch and colleagues reported in the August issue of Radiology.

"Our findings suggest that opening the carotid artery and restoring blood flow to the brain via a minimally invasive technique under local anesthesia is associated with significant reduction in depressive symptoms," Dr. Mlekusch said. "We were able to demonstrate a clear neuropsychological benefit to patients after carotid stenting."

The researchers enrolled 143 patients slated to undergo carotid stenting because of high-grade stenosis, as well as a control group of 102 patients who whose carotid arteries were not narrowed, but who were scheduled for percutaneous transluminal angioplasty because of peripheral artery disease.

All participants were evaluated for depressive symptoms with the Beck Depression Inventory (BDI) within three days of the planned treatment, and four weeks after treatment. At baseline, 33.6% of patients with carotid stenosis and 16.7% of the patients with peripheral artery disease had relevant depressive symptoms, a difference that was significant at P=0.003.

After treatment, the proportion of controls with depressive symptoms was 13.0% -- a non-significant change from baseline, the researchers found.

However, among the carotid stenting patients the proportion with depressive symptoms fell sharply, from 33.6% to 9.8%. The difference was significant at P<0.001. Also, the mean score on the BDI also fell significantly, at P<0.001.

The carotid stenting procedure also reduced the differences between the groups. At the four-week follow-up, there was no statistically significant difference in frequency of depressive symptoms between patients with former carotid artery stenosis after carotid stenting and controls with peripheral artery disease.

The researchers also re-examined a subset of 29 carotid stenting patients four months after treatment and found that neither the frequency of substantial depressive symptoms nor the BDI score had changed significantly, compared with the four-week results for the whole group, implying that the benefit was lasting.

The study is the second in recent months to report cognitive changes after carotid stenting: At the 2006 meeting of the Society of Interventional Radiology, U.S. researchers reported that carotid stenting led to dramatically improved cognition in patients who in many cases had been institutionalized.

Rodney Rabbe, M.D., of Sacred Heart Medical Center in Spokane, Wash., said some patients were able to resume activities -- including jobs or living independently -- that they had been obliged to give up. He did not report on depression, but noted that the finding implies that so-called "asymptomatic" carotid stenosis may be a misnomer.

"If there is such a significant cognitive improvement in asymptomatic patients, then they weren't asymptomatic," he said. "They didn't think as well as they should."

Dr. Mlekusch said that carotid stenting, while valuable for depression related to the cerebral vasculature, should not be thought of as a cure for depression with other causes.

The authors of the study pointed out that one limitation to consider was the selection of the control group. "The selection of adequate control subjects is a critical issue and has to be considered when interpreting our findings," they wrote. "There may be differences in psychologic stress for the patient before carotid or lower-limb percutaneous transluminal angioplasty, and these differences may affect the Beck Depression Inventory score."