接受颈动脉支架置入术治疗的患者中重度认知功能障碍的发生率。
Incidence of moderate to severe cognitive dysfunction in patients treated with carotid artery stenting.
作者信息
Gaudet John G, Meyers Philip M, McKinsey James F, Lavine Sean D, Gray William, Mitchell Elizabeth, Connolly E Sander, Heyer Eric J
机构信息
Department of Anesthesiology, Columbia University, New York, New York 10032, USA.
出版信息
Neurosurgery. 2009 Aug;65(2):325-9; discussion 329-30. doi: 10.1227/01.NEU.0000349920.69637.78.
OBJECTIVE
Approximately 25% of patients with carotid artery stenosis treated with carotid endarterectomy develop cognitive dysfunction (CD) between 1 day and 1 month after surgery compared with a control group. We hypothesized that patients with carotid artery stenosis treated with carotid artery stenting (CAS) performed under cerebral embolic protection also develop CD at similar time points compared with a control group.
METHODS
Twenty-four patients scheduled for elective CAS were enrolled in a prospective institutional review board-approved study to evaluate cognitive function with a battery of 6 neuropsychometric tests before, and 1 day and 1 month after, CAS. Test performance was compared with 23 patients undergoing coronary artery procedures (control group). The mean and standard deviation of the difference scores in the control group were used to generate Z scores. We used a previously described point system to transform negative Z scores into injury points for each neuropsychometric test. Global performance is presented as average deficit score (sum of injury points divided by the number of completed tests). All patients underwent the procedures with mild sedation. Results were analyzed in 2 ways: group-rate and event-rate analysis. Outcome was dichotomized by defining moderate to severe CD as average deficit score at least 1.5 standard deviations worse than the control group. Fisher tests and multivariate logistic regression models were used to analyze group performance.
RESULTS
Control patients tended to be younger and had a lower incidence of stroke or previous transient ischemic attack. One day after surgery, 41% of patients (10 of 24) treated with CAS developed moderate to severe CD (P = 0.0422). Average deficit score was also significantly higher in the CAS group at 1 day (P = 0.0265). These differences were independent of age and history of stroke/transient ischemic attack. Interestingly, we found that the absence of oral statin medication may increase the probability of CD. By 1 month, 9% of patients (1 of 11) treated with CAS presented with CD. Other patients were lost to follow-up.
CONCLUSION
CAS is associated with a decline in cognitive performance that is at least moderate 1 day after surgery.
目的
与对照组相比，接受颈动脉内膜切除术治疗的颈动脉狭窄患者中约25%在术后1天至1个月内出现认知功能障碍（CD）。我们推测，在脑栓塞保护下接受颈动脉支架置入术（CAS）治疗的颈动脉狭窄患者在相似时间点也会出现CD。
方法
24例计划接受择期CAS的患者被纳入一项经机构审查委员会批准的前瞻性研究，在CAS术前、术后1天和1个月通过一系列6项神经心理测试评估认知功能。将测试表现与23例接受冠状动脉手术的患者（对照组）进行比较。对照组差异分数的均值和标准差用于生成Z分数。我们使用先前描述的评分系统将每个神经心理测试的负Z分数转换为损伤分数。整体表现以平均缺陷分数表示（损伤分数总和除以完成测试的数量）。所有患者均在轻度镇静下接受手术。结果通过两种方式进行分析：组率分析和事件率分析。通过将中度至重度CD定义为平均缺陷分数比对照组至少差1.5个标准差来进行结果二分法。使用Fisher检验和多因素逻辑回归模型分析组表现。
结果
对照患者往往更年轻，中风或既往短暂性脑缺血发作的发生率更低。术后1天，接受CAS治疗的患者中有41%（24例中的10例）出现中度至重度CD（P = 0.0422）。CAS组术后1天的平均缺陷分数也显著更高（P = 0.0265）。这些差异与年龄和中风/短暂性脑缺血发作史无关。有趣的是，我们发现未服用口服他汀类药物可能会增加出现CD的概率。到1个月时，接受CAS治疗的患者中有9%（11例中的1例）出现CD。其他患者失访。
结论
CAS与术后1天认知功能至少中度下降有关。
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