Migliara Bruno, Trentin Michela, Idone Domenico, Mirandola Mattia, Griso Andrea, Lino Marcello
Vascular and Endovascular Surgery Division, Department of Surgery, Casa di Cura, Dott. Pederzoli, Peschiera del Garda, Verona, Italy.
Ann Vasc Surg. 2013 Aug;27(6):727-35. doi: 10.1016/j.avsg.2012.06.029. Epub 2013 May 22.
The effects of carotid endarterectomy (CEA) on cognitive function have yet to be fully elucidated. The aim of our study was to administer a battery of cognitive tests to identify any cognitive changes occurring in a consecutive series of patients who underwent CEA using the eversion technique under local anesthesia.
This prospective study was designed to analyze a consecutive series of patients undergoing eversion CEA under local anesthesia for significant carotid stenosis at our vascular surgery unit over a period of 6 months. Patients underwent tests to rule-out those who already had cognitive impairments or states of depression/anxiety capable of interfering with cognitive testing outcomes. Patients then completed a battery of 10 neurocognitive tests preoperatively and again 30 days and 4 months after surgery to assess the functions of both cerebral hemispheres as thoroughly as possible.
Of the 48 patients initially considered for our study, 39 completed the follow-up. They were 71.4 ± 8.2 (mean ± SD) years of age; 30 were men and 9 were women. Six were symptomatic for carotid stenosis and 33 were asymptomatic. All patients were examined by a neurologist and underwent pre- and postoperative nuclear MRI or CT scan of the brain to identify any cerebral ischemia potentially correlated with the surgical procedure. In all cases, the cognitive test findings tended to improve postoperatively; this improvement was statistically significant in 7 tests. Post-hoc analysis confirmed an improvement between the pre- and postoperative test results. Among the different variables considered, only age <75 years seems to have influenced cognitive improvement.
The effects on cognitive function of carotid stenosis, particularly CEA, is still a much debated issue. The data reported in the literature vary considerably, preventing any final conclusions from being drawn. The mechanisms capable of inducing changes in cognitive status after CEA have yet to be precisely clarified. In our study, a suitable battery of tests were used to analyze the trend of cognitive function correlating with eversion CEA under local anesthesia. Our results demonstrate substantially improved cognitive function after CEA, which was statistically significant in 7 of 10 tests. We surmise that the CEA procedure, per se, can help to protect patients against cognitive deterioration, especially in those <75 years of age.
颈动脉内膜切除术（CEA）对认知功能的影响尚未完全阐明。我们研究的目的是进行一系列认知测试，以确定在局部麻醉下采用外翻技术接受CEA的连续患者中发生的任何认知变化。
这项前瞻性研究旨在分析在6个月内于我们血管外科接受局部麻醉下外翻CEA治疗严重颈动脉狭窄的连续患者系列。患者接受测试以排除那些已经存在认知障碍或能够干扰认知测试结果的抑郁/焦虑状态的患者。然后患者在术前以及术后30天和4个月完成一系列10项神经认知测试，以尽可能全面地评估双侧大脑半球的功能。
最初考虑纳入我们研究的48例患者中，39例完成了随访。他们的年龄为71.4±8.2（平均±标准差）岁；30例为男性，9例为女性。6例有颈动脉狭窄症状，33例无症状。所有患者均由神经科医生检查，并在术前和术后接受脑部核磁共振成像（MRI）或计算机断层扫描（CT）以识别任何可能与手术相关的脑缺血。在所有情况下，认知测试结果术后往往有所改善；在7项测试中这种改善具有统计学意义。事后分析证实了术前和术后测试结果之间的改善。在考虑的不同变量中，只有年龄<75岁似乎对认知改善有影响。
颈动脉狭窄，尤其是CEA对认知功能的影响仍然是一个备受争议的问题。文献报道的数据差异很大，无法得出任何最终结论。CEA后能够引起认知状态变化的机制尚未完全阐明。在我们的研究中，使用了一组合适的测试来分析与局部麻醉下外翻CEA相关的认知功能趋势。我们的结果表明CEA后认知功能有显著改善，在10项测试中的7项具有统计学意义。我们推测CEA手术本身可以帮助保护患者免受认知功能恶化，特别是在年龄<75岁的患者中。
