Witt Karsten, Börsch Katharina, Daniels Christine, Walluscheck Knut, Alfke Karsten, Jansen Olav, Czech Norbert, Deuschl Günther, Stingele Robert
Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 10, 24105 Kiel, Germany.
J Neurol. 2007 Nov;254(11):1524-32. doi: 10.1007/s00415-007-0576-x. Epub 2007 Jul 31.
Previous studies compared carotid endarterectomy (CEA) and carotid artery stent placement (CAS) for treatment of symptomatic carotid artery stenosis. Whereas most previous studies showed both treatment modalities to be associated with a comparable risk of periprocedural cerebrovascular complications, these previous studies have shown significantly more microemboli and significantly more lesions in diffusion-weighted MR imaging after CAS compared to CEA. The clinical relevance of these differences remains unknown. We therefore compared the neuropsychological consequences of CAS and CEA and additionally measured the S100beta protein, a marker of cerebral damage.
A total of 48 patients with symptomatic carotid artery stenosis greater than 70 % (according to ECST criteria) were enrolled and 45 patients participated in the follow-up. The patients were randomly assigned for CEA (24 patients) or CAS (21 patients). S100beta protein values were evaluated 2 hours before the procedure, as well as one and two hours thereafter. Patients were assessed before treatment, and again 6 and 30 days after treatment using a comprehensive neuropsychological test battery.
Patients of the CAS and the CEA groups did not significantly differ in terms of age, gender, education, degree of carotid artery stenosis, cerebrovascular symptoms and vascular risk factors. Following previously used criteria, a cognitive change in patients was assumed to have occurred when there was a decline of more than one standard deviation in two or more tests assessing various cognitive domains. Six days and 30 days after the treatment both groups showed a comparable number of patients with cognitive changes compared to baseline. There were no significant differences in S100beta protein values.
These results provide some reassurance that CAS is not associated with greater cognitive deterioration than CEA is.
既往研究比较了颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）治疗有症状颈动脉狭窄的效果。尽管既往大多数研究表明两种治疗方式围手术期脑血管并发症风险相当，但这些研究显示，与CEA相比，CAS术后弥散加权磁共振成像中的微栓子明显更多，损伤也明显更多。这些差异的临床相关性尚不清楚。因此，我们比较了CAS和CEA的神经心理学后果，并额外检测了脑损伤标志物S100β蛋白。
共纳入48例有症状颈动脉狭窄大于70%（根据欧洲颈动脉外科试验[ECST]标准）的患者，45例患者参与了随访。患者被随机分配接受CEA（24例患者）或CAS（21例患者）。在手术前2小时以及术后1小时和2小时评估S100β蛋白值。在治疗前以及治疗后6天和30天使用综合神经心理测试组对患者进行评估。
CAS组和CEA组患者在年龄、性别、教育程度、颈动脉狭窄程度、脑血管症状和血管危险因素方面无显著差异。按照先前使用的标准，当评估各个认知领域的两项或更多测试中下降超过一个标准差时，假定患者发生了认知变化。与基线相比，治疗后6天和30天两组出现认知变化的患者数量相当。S100β蛋白值无显著差异。
这些结果让人放心，即CAS与认知功能恶化程度高于CEA无关。
