{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:12:19Z","timestamp":1789661539298,"version":"4.0.1"},"reference-count":46,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neuroepidemiology"],"abstract":"<jats:p>Objective: Severe carotid artery stenosis (CAS) impairs cerebral blood flow and cognitive function. Revascularization may improve outcomes, but patient selection and timing remain challenging. This review synthesizes evidence on pre-revascularization risk factors. This systematic review synthesizes pre-revascularization evidence on CAS-related cognitive decline and evaluates timing, restenosis, high-risk subgroups (dialysis, radiation-induced, and sex), bilateral stenosis, hyperperfusion, and risk for stroke\/death\/MI outcomes. Method: A systematic search of PubMed, Scopus, EBSCO, Web of Science, SciFinder, and Emerald databases identified 22 published studies that reported quantitative pre-revascularization data between 2013 and 2026. The search was restricted to English-language studies. Results: Severe CAS (\u226570%) impairs memory, attention, and executive function (MMSE +0.9 post-revascularization, p = 0.019; MoCA R = \u22120.359, p &lt; 0.001). Modern medical therapy reduced 120-day stroke risk to 1.97% (vs. historical 5%); large carotid internal lumen (CIL) volume (\u22654,000 mm3) predicts stroke (OR 4.6); urgent TFCAS riskier than carotid endarterectomy (CEA) (6.5% vs. 4.0%); restenosis higher after CAS (40% vs. 18% CEA). High-risk subgroups: dialysis (4.7% 30-day mortality; 43.4% 3-year survival), radiation-induced (86% vulnerable plaques), female TFCAS (OR 2.85 stroke\/death), contralateral occlusion (CAS OR 2.90), octogenarians (TF-CAS 6.6% vs. CEA 2.5%). Bilateral stenosis requires carotid vascular reserve (CVR)-guided staging. Conclusion: Pre-revascularization cognitive assessment identifies treatment-responsive deficits. Timing should be individualized (delay large CIL); CEA preferred for high-risk anatomy. Novel risk stratification (dialysis, radiation, female sex, and bilateral CVR) guides patient selection beyond traditional stenosis degree.<\/jats:p>","DOI":"10.1159\/000552651","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T16:00:59Z","timestamp":1785340859000},"page":"1-16","source":"Crossref","is-referenced-by-count":0,"title":["Bridging Evidence Gaps in Severe Carotid Stenosis: A Systematic Review of Pre-Revascularization Risk Stratification, Clinical Predictors, and High-Risk Subgroups"],"prefix":"10.1159","author":[{"given":"Mohammad Minwer","family":"Alnaeem","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.4103\/bc.bc_36_22"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.01.038"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000020637"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2019.03.028"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.3171\/2015.1.JNS142452"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s40271-018-0337-1"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.2174\/1567202616666190129153409"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11113019"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1237130"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1080\/07399332.2021.1955889"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.09.020"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002354"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2021.02.024"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2016.08.077"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.5114\/aic.2023.125610"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2014.10.002"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.03.021"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2021.08.051"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.04.055"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2020.10.023"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2023.09.001"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.rec.2021.07.010"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.5114\/aic.2017.70190"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2020.03.043"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2022.04.027"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.009745"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.10.066"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2018.07.062"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.04.390"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.5551\/jat.42176"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104702"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2022.07.056"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000030605"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S192586"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1046\/j.1445-2197.2003.02748.x"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011458"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.21037\/atm-20-392a"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-138-1-200301070-00012-w1"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-026-13766-5"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvn.2017.11.001"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/3916361"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-021-02385-4"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/6634537"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2025.111219"}],"container-title":["Neuroepidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000552651","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:01:15Z","timestamp":1789660875000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000552651"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":46,"URL":"https:\/\/doi.org\/10.1159\/000552651","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.33102164","asserted-by":"subject"}]},"ISSN":["0251-5350","1423-0208"],"issn-type":[{"value":"0251-5350","type":"print"},{"value":"1423-0208","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]}}}