Capoccia Laura, Sbarigia Enrico, Rizzo Annarita, Mansour Wassim, Speziale Francesco
Vascular Surgery Division, Department of Surgery 'Paride Stefanini', Policlinico Umberto I, 'Sapienza' University of Rome, Italy.
Vascular. 2012 Aug;20(4):181-7. doi: 10.1258/vasc.2011.oa0342. Epub 2012 Jun 25.
The aim of this study was to assess the relationship between serum levels of S100β and neuron-specific enolase (NSE), postoperative diffusion-weighted magnetic resonance imaging (DW-MRI) and Mini-Mental State Examination (MMSE) score in asymptomatic patients affected by ≥ 70% carotid stenosis submitted to carotid endarterectomy (CEA) or carotid artery stenting (CAS), and to compare MMSE scores and DW-MRI findings at follow-up evaluations. Between April 2008 and April 2009, 60 patients were submitted to carotid intervention. All patients underwent DW-MRI and MMSE preoperatively, at 24 hours postoperatively, at 6 months and at 12 months. Neurobiomarkers were assessed for each patient at six time-points. Thirty-two patients were submitted to CEA and 28 to CAS. No mortality was observed. One CAS patient presented with an ischemic stroke. In six CAS patients and one CEA patient, new subclinical ischemic lesions were detected at postoperative DW-MRI (21.4% versus 3%, P = 0.03). In CAS patients, new DW-MRI lesions were significantly associated with MMSE score decline (P = 0.001). At 12 months, patients presenting with new postoperative ischemic lesions showed lower MMSE scores (P = 0.08). CAS patients showed increasing neurobiomarker levels compared with CEA patients (P = 0.02). In conclusion, microembolization effects may persist over time, so it should be avoided whenever possible. Carotid revascularization procedures should be evaluated and compared not only with respect to death/stroke but also to microembolism rates.
本研究旨在评估无症状性颈动脉狭窄≥70%且接受颈动脉内膜切除术（CEA）或颈动脉支架置入术（CAS）的患者血清S100β和神经元特异性烯醇化酶（NSE）水平、术后弥散加权磁共振成像（DW-MRI）与简易精神状态检查表（MMSE）评分之间的关系，并比较随访评估时的MMSE评分和DW-MRI结果。2008年4月至2009年4月期间，60例患者接受了颈动脉干预。所有患者在术前、术后24小时、6个月和12个月均接受了DW-MRI和MMSE检查。在六个时间点对每位患者的神经生物标志物进行了评估。32例患者接受了CEA，28例接受了CAS。未观察到死亡病例。1例CAS患者发生缺血性卒中。在6例CAS患者和1例CEA患者中，术后DW-MRI检测到新的亚临床缺血性病变（21.4%对3%，P = 0.03）。在CAS患者中，新的DW-MRI病变与MMSE评分下降显著相关（P = 0.001）。在12个月时，出现术后新缺血性病变的患者MMSE评分较低（P = 0.08）。与CEA患者相比，CAS患者的神经生物标志物水平升高（P = 0.02）。总之，微栓塞效应可能会随时间持续存在，因此应尽可能避免。颈动脉血运重建手术不仅应在死亡/卒中方面进行评估和比较，还应在微栓塞发生率方面进行评估和比较。
