Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, PO Box 85500, G03.228, 3508 GA Utrecht, the Netherlands.
Neurology. 2011 Sep 13;77(11):1084-90. doi: 10.1212/WNL.0b013e31822e55b9. Epub 2011 Aug 31.
To compare the effect on cognition of carotid artery stenting (CAS) and carotid endarterectomy (CEA) for symptomatic carotid artery stenosis.
Patients randomized to CAS or CEA in the International Carotid Stenting Study (ICSS; ISRCTN25337470) at 2 participating centers underwent detailed neuropsychological examinations (NPE) before and 6 months after revascularization. Ischemic brain lesions were assessed with diffusion-weighted imaging before and within 3 days after revascularization. Cognitive test results were standardized into z scores, from which a cognitive sumscore was calculated. The primary outcome was the change in cognitive sumscore between baseline and follow-up.
Of the 1,713 patients included in ICSS, 177 were enrolled in the 2 centers during the substudy period, of whom 140 had an NPE at baseline and 120 at follow-up. One patient with an unreliable baseline NPE was excluded. CAS was associated with a larger decrease in cognition than CEA, but the between-group difference was not statistically significant: -0.17 (95% CI -0.38 to 0.03; p = 0.092). Eighty-nine patients had a pretreatment MRI and 64 within 3 days after revascularization. New ischemic lesions were found twice as often after CAS than after CEA (relative risk 2.1; 95% CI 1.0 to 4.4; p = 0.041).
Differences between CAS and CEA in effect on cognition were not statistically significant, despite a substantially higher rate of new ischemic lesions after CAS than after CEA.
This study provides Class III evidence that any difference between the effects of CAS and CEA on cognition at 6 months after revascularization is small.
比较颈动脉支架置入术（CAS）和颈动脉内膜切除术（CEA）治疗症状性颈动脉狭窄对认知功能的影响。
在国际颈动脉支架置入研究（ICSS；ISRCTN25337470）中，随机分配至 CAS 或 CEA 治疗的 2 个参与中心的患者，在血管重建术前和术后 6 个月接受详细的神经心理学检查（NPE）。在血管重建术前和术后 3 天内使用弥散加权成像评估缺血性脑损伤。将认知测试结果标准化为 z 分数，从中计算认知总分。主要结局为从基线到随访期间认知总分的变化。
在 ICSS 中纳入的 1713 例患者中，有 177 例在亚研究期间入组这 2 个中心，其中 140 例在基线时有 NPE，120 例在随访时有 NPE。排除了 1 例基线 NPE 不可靠的患者。CAS 与认知功能下降的相关性大于 CEA，但组间差异无统计学意义：-0.17（95%CI-0.38 至 0.03；p = 0.092）。89 例患者在预处理 MRI 上有病灶，64 例在血管重建术后 3 天内有病灶。CAS 后新发缺血性病灶的发生率是 CEA 后的 2 倍（相对风险 2.1；95%CI 1.0 至 4.4；p = 0.041）。
尽管 CAS 后新发缺血性病灶的发生率明显高于 CEA，但 CAS 和 CEA 在认知功能方面的影响差异无统计学意义。
本研究提供了 III 级证据，表明血管重建术后 6 个月时 CAS 和 CEA 对认知的影响之间的任何差异都很小。
