Background: Vascular cognitive impairment (VCI) refers to a broad spectrum of syndromes ranging from mild cognitive impairment to dementia caused by overt or non-overt cerebrovascular disease. Carotid endarterectomy (CEA) has been shown to be effective in reducing the risk of plaque detachment in patients with CAS, as well as increasing the blood supply to the brain, offering the possibility of delaying the onset of dementia in CAS patients. In this study, patients with carotid atherosclerotic stenosis treated with CEA in our department were selected and their cerebral perfusion and cognitive function were monitored before and after surgery, respectively, with the aim of comparing the cognitive function of domestic patients with carotid atherosclerotic stenosis before and after CEA surgery, observing the effect of CEA on cognitive function of patients with carotid stenosis, and evaluating the therapeutic improvement of CEA on VCI caused by CAS. effect. METHODS: Patients with 65% to 95% carotid artery stenosis were included in this study. The main manifestations were recurrent TIA, mild limb paralysis and transient aphasia or asymptomatic, and some had a clear history of cerebral infarction without significant social functional limitations. All patients had a very smooth surgical procedure with normal recovery. Preoperative and postoperative MRI: PWI contrast findings revealed significant improvement in perfusion on the side of the lesion, as evidenced by significant shortening of TTP, rMTT, and T0, and significant reduction in rCBV, but no significant change in rCBF. Some patients had new infarct foci visible on DWI postoperatively, and none of the patients had obvious conscious symptoms. Preoperative MMSE and MoCA assessments revealed that all CAS patients had varying degrees of cognitive dysfunction; postoperative patients had no significant change in MMSE scores compared with preoperative scores, while MoCA scores showed significant improvement compared with preoperative scores; among the MoCA individual scores, the differences in visuospatial executive ability, attention and abstract generalization ability were statistically significant compared with preoperative scores. Patients with new infarcts were grouped independently and compared with other patients for postoperative NPEs, and the results showed that there was no statistical difference in MMSE scores between this group and the group without new infarcts, and the MoCA scores of patients with new infarcts did not improve significantly compared with those before surgery. DISCUSSION: At present, China has entered the stage of social population aging, and how to prevent and treat VCI has become the focus of our attention. The data in this study showed that most of the CAS patients were accompanied by different degrees of cognitive dysfunction, and some patients may not have the degree of carotid artery stenosis up to the surgical standard, and they have no obvious discomfort symptoms, but their cognitive function has been impaired. In this group of patients, the improvement of the blood supply to the central nervous system after CEA has facilitated the emotional and cognitive recovery to a certain extent, suggesting that patients with VCI with CAS may be able to achieve some therapeutic effect through active surgical management. In the early stages of cognitive dysfunction in patients with carotid stenosis, the surgeon may consider the patient’s cognitive level assessment when making the diagnosis of CAS and the development of the surgical plan. Given that surgical treatment of CEA has the potential to reverse or delay cognitive impairment, halt the progression of VMCI, and improve emotional-cognitive function, this positive effect of surgical treatment of emotional and cognitive aspects of VCI patients could potentially be extended to a wider range of patients to prevent further cognitive impairment from the next “cerebrovascular event”. However, more samples and more accurate assessment methods and studies are needed to support this hypothesis and recommendation.