Chida Kohei, Ogasawara Kuniaki, Suga Yasunori, Saito Hideo, Kobayashi Masakazu, Yoshida Kenji, Otawara Yasunari, Ogawa Akira
Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan.
Stroke. 2009 Feb;40(2):448-53. doi: 10.1161/STROKEAHA.108.515775. Epub 2008 Dec 12.
Although cerebral hyperperfusion after carotid endarterectomy (CEA) often impairs cognitive function, MRI does not always demonstrate structural brain damage associated with postoperative cognitive impairment. The purpose of the present study was to determine whether postoperative cortical neural loss, which can be detected by (123)I-iomazenil single-photon emission CT, is associated with cerebral hyperperfusion after CEA and whether it correlates with postoperative cognitive impairment.
In 60 patients undergoing CEA for ipsilateral internal carotid artery stenosis (>70%), cerebral blood flow was measured using N-isopropyl-p-[(123)I]-iodoamphetamine single-photon emission CT before and immediately after CEA and on the third postoperative day. The distribution of benzodiazepine receptor binding potential in the cerebral cortex was assessed using (123)I-iomazenil single-photon emission CT before and 1 month after surgery and was analyzed using 3-dimensional stereotactic surface projection. Neuropsychological testing was also performed preoperatively and at the first postoperative month.
Post-CEA hyperperfusion and postoperative cognitive impairment were observed in 9 patients (15%) and 8 patients (13%), respectively. Post-CEA hyperperfusion was significantly associated with postoperative hemispheric reduction of benzodiazepine receptor binding potential (95% CIs, 2.765 to 148.804; P=0.0031). Post-CEA hyperperfusion (95% CIs, 1.183 to 229.447; P=0.0370) and postoperative hemispheric reduction of benzodiazepine receptor binding potential (95% CIs, 1.003 to 77.381; P=0.0496) were also significantly associated with postoperative cognitive impairment.
Cerebral hyperperfusion after CEA results in postoperative cortical neural loss that correlates with postoperative cognitive impairment.
尽管颈动脉内膜切除术（CEA）后出现的脑血流灌注过多常损害认知功能，但MRI并不总是能显示出与术后认知障碍相关的脑结构损伤。本研究的目的是确定术后皮质神经细胞丢失（可通过（123）I-碘西泮单光子发射计算机断层扫描检测到）是否与CEA后的脑血流灌注过多相关，以及它是否与术后认知障碍相关。
对60例因同侧颈内动脉狭窄（>70%）而接受CEA的患者，在CEA前、CEA后即刻及术后第3天使用N-异丙基-p-[(123)I]-碘安非他明单光子发射计算机断层扫描测量脑血流量。在手术前和术后1个月使用（123）I-碘西泮单光子发射计算机断层扫描评估大脑皮质中苯二氮䓬受体结合电位的分布，并使用三维立体定向表面投影进行分析。术前和术后第1个月也进行了神经心理学测试。
分别有9例患者（15%）出现CEA后脑血流灌注过多，8例患者（13%）出现术后认知障碍。CEA后脑血流灌注过多与术后半球苯二氮䓬受体结合电位降低显著相关（95%可信区间为2.765至148.804；P=0.0031）。CEA后脑血流灌注过多（95%可信区间为1.183至229.447；P=0.0370）和术后半球苯二氮䓬受体结合电位降低（95%可信区间为1.003至77.381；P=0.0496）也与术后认知障碍显著相关。
CEA后脑血流灌注过多导致术后皮质神经细胞丢失，这与术后认知障碍相关。
