Carotid artery stenosis (CAS) is a major cause of ischemic stroke and an independent risk factor for vascular cognitive impairment. CAS may contribute to progressive cognitive decline through chronic cerebral hypoperfusion, microembolic burden, blood-brain barrier disruption and neuroinflammation, even during asymptomatic stages. Conventional cognitive scales are influenced by education, cooperation and testing conditions and are insufficiently sensitive to subtle early changes, highlighting the need for objective biomarkers. This review summarizes biological biomarkers, including systemic and neuroinflammatory markers, lipid-related markers, vascular/neuronal injury markers, glial activation markers and genetic markers, as well as multimodal imaging biomarkers covering brain structure, white matter integrity, cerebral perfusion/metabolism and functional connectivity.

Markers such as CRP, IL-6, TNF-α, homocysteine, lipocalin-2, p-tau217, GFAP, and APOE ε4 are associated with cognitive dysfunction in CAS. Imaging findings include gray/white matter atrophy, cortical thinning, white matter hyperintensities, reduced fractional anisotropy, cerebral hypoperfusion, metabolic deficits and disrupted functional networks such as the default mode network. These biomarkers correlate with cognitive scores and show changes after revascularization, supporting potential roles in early detection and treatment monitoring. The review notes heterogeneity in biomarker measurement and lack of standardized thresholds. Integrating biological and imaging biomarkers may improve early detection, risk stratification and precision management; large prospective studies are needed before clinical implementation. The authors emphasize mechanistic links between atherosclerosis, neuroinflammation, neuronal injury and brain network disruption. The work entitled “Research Progress on Biological Markers and Imaging Markers of Cognitive Impairment Associated with Carotid Artery Stenosis” was published in Translational Neurology and Neurosurgery (Volume 1, Issue 2, 2026)
DOI: 10.2738/TNN.2026.0006