A total of 39 patients with a mean age of 71.52 years (range 50-90) were treated with CAS. Patientdemographics, risk factors, and morbidities are listed in (Table 1).

Regarding neuroimaging after CAS, multifocal restriction DWI occurred in 7.69% of patients with severe and moderade stenosis(3/39), Hypointensity in SWI in another 10.26% of patients (4/39), and focal restriction DWI in 33.33% of patients (13/39), although none of the patients reported a relevant clinical deficit. The degree of stenosis demonstrated a statistically significant correlation (p= 0,021) with the appearance of neuroimaging findings after CAS in (Table 2), so patients who presented post-procedural multifocal restriction DWI were more likely to have a high grade of stenosis. All patients who presented multifocal restriction DWI (n=3/39) had a stenosis greater than 70%.

Of the initial 80 patients evaluated for pre-selection with the cognitive evaluation one year postoperation, a total of 41 patients were excluded for various reasons: 10 patients (12.5%) declined to participate, 28 patients (35%) did not meet inclusion criteria, 12 patients (15%) were excluded due to rejected neuroimaging studies, and 8 patients (10%) were lost to follow-up. After exclusions, 42 patients remained. During the study, 3 patients (7.14% of those selected) died due to comorbidities unrelated to the carotid stent within the following 6 months, leading to a final number of 39 patients selected for the study. These patients underwent neuroimaging (MRI) andMoCA tests both before and after CAS.

A total of 100% of the included patients completed the neurocognitive tests (39/39), 53.85% of patients (21/39) were classified as cognitive responders to the treatment (having improved 3 points in the MoCa test at least 2 tests), while 46.15% of patients (18/39) were considered non-responders.

Predisposing factors that demonstrated a negative correlation were kidney disease (p=0.032) and a history of having been treated with cervical radiotherapy (p=0.042) which predisposes to lack of cognitive response. However, there is a positive correlation with relevant statistical significance (p=0.003) in patients with a higher level of education who tend to have a positive cognitive response in the tests carried out compared to patients with a lower level of education (Table 3).

The result of PVF, SVF and the global scores of the MoCa test in responding patients are significantly lower than in non-responders, highlighting a difference in the total score of the MoCa test of 4.85 points between responders and non-responders with a p =0.02 significant. Although it should be noted that high scores on the pre-CAS neurocognitive assessment were less likely to be classified in the final group of responders. The cognitive performance of the patients before (T0) and after 12 months (T1) of carotid revascularization is summarized in (Table 4).

When patients were divided according to the side of carotid revascularization right internal carotid artery (RICA) versus left internal carotid artery (LICA), the RICA group showed improvement in visuospatial tasks, identification, attention, language, abstraction, and memory, but showed reductions in orientation. After 12 months, there were also some differences in the LICA group that showed only reductions in identification scores. (Table 5)

Additionally, a global comparison of the study sample in neurocognitive tests for patients pre-CAS (T0), after 6 months (T6M), and one year (T1A) post-revascularization is provided in (Table 6).

A total of 3/49 patients (6.12%) died in this 12-month follow-up period. Of these patients, only 1 case occurred due to a neurological etiology, due to an ipsilateral stroke of the treated carotid artery, more than 30 days after CAS implantation. The rest of the cases were due to other non-neurological causes in relation to the patients comorbidities. A survival of 94.23% of the sample was demonstrated one year after carotid stent implantation.