Mlekusch Wolfgang, Mlekusch Irene, Haumer Markus, Kopp Christoph W, Lehrner Johann, Ahmadi Ramazanali, Koppensteiner Renate, Minar Erich, Schillinger Martin
Department of Internal Medicine II, Division of Angiology, Medical University Vienna, Vienna, Austria.
Catheter Cardiovasc Interv. 2008 Jan 1;71(1):114-9. doi: 10.1002/ccd.21407.
To investigate the effect of protected carotid artery stenting on neurocognitive function with particular consideration of the angiographic filling of the ipsilateral anterior cerebral artery (ACA).
An improved inflow to the supply area of the anterior cerebral artery after revascularisation of severe carotid artery stenosis may beneficially affect frontal lobe cognitive functions.
We prospectively included 71 consecutive patients who underwent carotid artery stenting (CAS) due to high grade carotid artery stenosis. Intracranial angiograms and filling status of the ACA pre- and post-stenting were analyzed and a battery of 5 selected neuropsychological tests for frontal lobe function were applied prior to and 6 months after CAS. Patients with improvement in at least two tests were defined as having improved neurocognitive function.
Compared to baseline, we found a significant improvement of the Trail-Making Test A (median 6% improved change-score; P = 0.01), the test of supermarket items showed a trend towards significant improvement (median 3.7% improved change-score; P = 0.09). In 32 patients (45%) an improvement of at least 2 neurocognitive tests was observed. Neuropsychological improvement was found more frequently in patients with a contrasted ipsilateral ACA after CAS (88%, 95% CI 77 to 99) compared to patients without angiographic filling of the ipsilateral ACA post CAS (13%, 95% CI 1 to 25), respectively (P < 0.01).
Carotid artery stenting improves neurocognitive function in a considerable proportion of patients. A contrasted ipsilateral anterior cerebral artery after CAS is associated with improved neurocognitive function, presumably due to amelioration of frontal lobe perfusion.
探讨颈动脉支架置入术对神经认知功能的影响，尤其考虑同侧大脑前动脉（ACA）的血管造影充盈情况。
严重颈动脉狭窄血管重建术后，大脑前动脉供血区域的血流改善可能对额叶认知功能产生有益影响。
我们前瞻性纳入了71例因重度颈动脉狭窄接受颈动脉支架置入术（CAS）的连续患者。分析了支架置入前后的颅内血管造影和ACA的充盈状态，并在CAS术前和术后6个月应用了一组5项选定的额叶功能神经心理学测试。至少两项测试有改善的患者被定义为神经认知功能改善。
与基线相比，我们发现连线测验A有显著改善（中位变化得分提高6%；P = 0.01），超市物品测试有显著改善的趋势（中位变化得分提高3.7%；P = 0.09）。32例患者（45%）观察到至少两项神经认知测试有改善。与CAS术后同侧ACA无血管造影充盈的患者（13%，95%CI 1至25）相比，CAS术后同侧ACA有造影剂充盈的患者神经心理学改善更频繁（88%，95%CI 77至99）（P < 0.01）。
颈动脉支架置入术可使相当一部分患者的神经认知功能得到改善。CAS术后同侧大脑前动脉有造影剂充盈与神经认知功能改善相关，可能是由于额叶灌注改善。
