Perioperative Predictors and Temporal Trajectories of Postoperative Cognitive Decline After Carotid Endarterectomy: A Prospective Cohort Study

Background/Objectives: Carotid artery stenosis is a well-established risk factor for vascular cognitive impairment. Although carotid endarterectomy (CEA) reduces the risk of ischemic stroke, its effect on cognitive function remains uncertain. Most previous studies have relied on mean changes in cognitive scores and have not defined postoperative cognitive decline using patient-level thresholds for the Montreal Cognitive Assessment (MoCA). Moreover, few studies have integrated perioperative variables across baseline, intraoperative, and postoperative domains to examine heterogeneity in cognitive outcomes. We therefore defined postoperative cognitive decline using threshold-based MoCA changes and prospectively evaluated perioperative factors associated with distinct cognitive outcomes after CEA.