Department of Internal Medicine, National Taiwan University Hospital, and Graduate Institute of Clinical Medicine, Medical College, Department of Psychology, National Taiwan University, 7 Chung-Shan South Road, Taipei, Taiwan.
Stroke. 2011 Oct;42(10):2850-4. doi: 10.1161/STROKEAHA.111.613133. Epub 2011 Aug 11.
Chronic cerebral hypoperfusion may lead to impairment in neurocognitive performance in patients with chronic internal carotid artery occlusion, and the effects of carotid artery stenting on neurocognitive function have been unclear.
We prospectively enrolled 20 chronic internal carotid artery occlusion patients with objective ipsilateral hemisphere ischemia, in whom carotid artery stenting was attempted. Functional assessments, including the National Institutes of Health Stroke Scale, Barthel Index, and a battery of neuropsychological tests, including the Mini-Mental State Examination, Alzheimer Disease Assessment Scale-Cognitive Subtest, verbal fluency, and Color Trail Making A and B, were administered before and 3 months after intervention.
Successful recanalization was achieved in 12 of 20 patients (60%). There was no procedural or new cerebral ischemic event, except for 1 intracranial hemorrhage, which occurred during the procedure and had neurologic sequelae; this case was excluded from analysis. The demographics and baseline cognitive performance were similar between the group with a successful outcome (group 1, n=12) and patients who did not (group 2, n=7). Ten of 12 patients in group 1 had improvement in ipsilateral brain perfusion after the procedure, but none in group 2 had improvement. Significant improvement in the scores on the Alzheimer Disease Assessment Scale-Cognitive Subtest (before, 7.7±8.9 versus after, 5.7±7.1; P=0.024), Mini-Mental State Examination (before, 25.8±3.8 versus after, 27.7±2.7; P=0.015), and Color Trail Making A (before, 123.2±68.6 versus after, 99.3±51.5; P=0.017) were found in group 1 but not in group 2.
Successful carotid artery stenting improves global cognitive function as well as attention and psychomotor processing speed in patients with chronic internal carotid artery occlusion.
慢性大脑低灌注可能导致慢性颈内动脉闭塞患者的神经认知表现受损，而颈动脉支架置入术对神经认知功能的影响尚不清楚。
我们前瞻性纳入 20 例慢性颈内动脉闭塞伴客观同侧半球缺血的患者，尝试进行颈动脉支架置入术。在干预前和干预后 3 个月，进行功能评估，包括美国国立卫生研究院卒中量表、巴氏指数和一系列神经心理学测试，包括简易精神状态检查、阿尔茨海默病评估量表认知子量表、言语流畅性测试和连线测试 A 和 B。
20 例患者中有 12 例（60%）成功再通。除 1 例术中发生颅内出血并伴有神经后遗症外（该病例被排除在分析之外），无手术相关或新发脑缺血事件。成功组（n=12）和未成功者（n=7）的一般资料和基线认知表现相似。12 例成功组患者中有 10 例术后同侧脑灌注改善，但未成功者均无改善。阿尔茨海默病评估量表认知子量表评分显著改善（术前 7.7±8.9 分，术后 5.7±7.1 分；P=0.024），简易精神状态检查评分（术前 25.8±3.8 分，术后 27.7±2.7 分；P=0.015）和连线测试 A 评分（术前 123.2±68.6 分，术后 99.3±51.5 分；P=0.017），但未成功者均无改善。
成功的颈动脉支架置入术可改善慢性颈内动脉闭塞患者的整体认知功能以及注意力和精神运动处理速度。
