颈动脉血运重建术后脑白质疏松症即刻逆转。

Immediate regression of leukoaraiosis after carotid artery revascularization.

机构信息

Department of Neurology, Far-Eastern Memorial Hospital, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC.

出版信息

Cerebrovasc Dis. 2011;32(5):439-46. doi: 10.1159/000330638. Epub 2011 Oct 14.

DOI:10.1159/000330638

PMID:22005278

Abstract

BACKGROUND

Leukoaraiosis (LA) affects cognition after stroke and reversal of LA may improve cognitive performance. We aimed to determine the impact of cerebral perfusion and circle of Willis (CoW) flow patterns on the extent of LA after carotid artery revascularization.

METHODS

LA was scored on fluid-attenuated inversion recovery magnetic resonance (MR) images at the levels of the centrum semiovale and frontal horns in both cerebral hemispheres of 62 contiguous patients (men/women = 38/24, mean age = 63.2 ± 8.4 years, range 44-82) before and after unilateral carotid artery revascularization. The pre- and poststenting differences in LA scores, CoW flow pattern on MR angiography, and MR perfusion parameters were analyzed.

RESULTS

The total LA score decreased from 9.87 ± 0.65 to 8.33 ± 0.72 after stenting (p = 0.03). The CoW was complete in 21 subjects and incomplete in 41 subjects. The incomplete CoW group had a higher preoperative LA load and higher cerebral interhemispheric asymmetry index, both of which decreased significantly postoperatively.

CONCLUSIONS

CoW anomalies may contribute to LA in patients with carotid artery stenosis, and restoration of cerebral perfusion by carotid artery revascularization can reduce LA severity.

摘要

背景

脑白质疏松症（LA）会影响中风后的认知功能，而 LA 的逆转可能会改善认知表现。我们旨在确定脑灌注和 Willis 环（CoW）血流模式对颈动脉血运重建后 LA 程度的影响。

方法

在 62 例连续患者（男/女=38/24，平均年龄 63.2±8.4 岁，范围 44-82 岁）的大脑半卵圆中心和额角的液体衰减反转恢复磁共振（MR）图像上对 LA 进行评分，分别在颈动脉血运重建前后。分析了 LA 评分、MR 血管造影上的 CoW 血流模式和 MR 灌注参数的术前和支架置入后的差异。