Page 373 - Read Online

Abdelhaliem et al. Vessel Plus 2020;4:31 I http://dx.doi.org/10.20517/2574-1209.2020.13 Page 7 of 9

or strokes, is detrimental to memory and executive functioning [31-34] . It has also been shown that cognitive
function can be improved in symptomatic patients following internal carotid artery recanalization using
[37]
both endarterectomy and carotid stenting [35,36] . Grunwald et al. have also shown cognitive improvements
in both word fluency and in delayed recall when under neuropsychological testing that was conducted 24 h
after internal carotid artery stenting in asymptomatic patients. Results in asymptomatic patients similar to
[30]
[38]
those outlined above have also been published by Wang et al. and Picchetto et al. .
To ameliorate the vascular-neuro-psychiatric axis as a causative element for tinnitus amongst other clinical
[39]
manifestations, Suh et al. demonstrated that balloon expandable intracranial stent placement can be
safely utilized in stable symptomatic patients. Adverse effect rates were far lower in the stable patient
[40]
group (4.1%) in comparison to the unstable patient group (25.9%). Terada et al. further published that
stent placement is significantly more effective than percutaneous angioplasty for stenosis in the petrous or
[41]
cavernous portion of the internal carotid and has low periprocedural morbidity (4.2%). Goessens et al. ,
demonstrated that internal carotid artery stenosis should be considered an independent risk factor for
[44]
[43]
[42]
stroke. Rao et al. , Mathiesen et al. and Bakker et al. added to this bulk of evidence and stated that
this contributes to the pathophysiology of depression and is also actually a risk factor for suicide in these
[45]
stroke patients .
Therapeutic effects of stenting do exist and is has shown to be superior to that observed by medical
prescriptions including selective serotonin reuptake inhibitors in these patient groups. However, in a study
[38]
by Picchetto et al. , it was observed that there was no difference amongst pre- and post-scoring in the
neuropsychological evaluation of both depression and anxiety carried out in asymptomatic internal carotid
artery stenosis patients who received stenting.

Nonetheless, the approach and its desired effect on selective endovascular stenting for managing the ill
effect of the vascular-neuro-psychiatric axis as a culpable cause for tinnitus has been demonstrated to be of
promising value and with reliable results.

CONCLUSION
Therapeutic and surgical interventions amongst others such as classical endarterectomy or the surge
of endovascular carotid stenting for the management of carotid artery disease-induced tinnitus may
ameliorate this clinical condition, but their application is not without complications, compounded with a
neurological disability or even death. No culpable evidence exists in the current era on what drives carotid
artery stenosis and how this correlates with tinnitus. The exact pathophysiological mechanism is yet to be
elucidated. The current reports of intervention are without meaningful and reliable evidence for managing
this condition. Further studies of multicentre nature and well-constructed and powered trials are very
much needed to build an evidence-based approach in an era of personalized and digital healthcare.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of this study: Abdelhaliem A, Howard C,
Bashir M, Elsantawy H, Al-Khaffaf H

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.