LAUSR

OBJECTIVE Balance and mobility function worsen with age, and more so for those with underlying chronic diseases. We have recently found that asymptomatic carotid artery stenosis (ACAS) restricts blood flow to the brain and may also contribute to balance and mobility impairment. This study tests the hypothesis that ACAS is a modifiable risk factor for balance and mobility impairment. The goal is to assess the impact of restoring blood flow to the brain by carotid revascularization on balance and mobility in patients with high-grade ACAS (≥70% diameter-reducing stenosis). METHODS Twenty adults (67.0±9.4 years) undergoing carotid endarterectomy for high-grade stenosis were enrolled. Balance and mobility assessments performed before- and six weeks- after revascularization included the Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Four Square Step Test (FSST), Dynamic Gait Index (DGI), Timed Up and Go (TUG), gait speed, Mini-BESTest, and Walk While Talk complex (WWTc) test. RESULTS Consistent with our prior findings, patients demonstrated reduced scores on the SPPB, BBS, DGI, TUG, and gait speed. Depending on the outcome measure, 25-90% of patients scored in the impaired range at baseline. After surgery, significant improvements were observed in the outcome measures that combined walking with dynamic movements, DGI (P=0.02), and Mini-BESTest (P=0.002). The percentage of patients with Mini-BESTest scores indicating high fall risk decreased significantly from 90% (n=18) at baseline to 40% (n=8) after surgery (p=0.02). Pearson's correlations examined the relationship between balance and mobility before surgery and the change score after surgery. Patients with lower baseline DGI and Mini-BESTest scores demonstrated the most improvement in follow-up testing (r=-0.59, p=0.006; r=-0.70, p=0.001, respectively). CONCLUSIONS Carotid revascularization improves balance and mobility, particularly measures that combine walking and dynamic movements. The greatest improvements were observed in patients that were most impaired at baseline.