Department of Vascular Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, PR China.
Department of Vascular and Endovascular Surgery, Nuremberg Southern Hospital, Nuremberg, Germany.
Eur J Vasc Endovasc Surg. 2015 Jul;50(1):5-12. doi: 10.1016/j.ejvs.2015.03.032. Epub 2015 Apr 29.
To investigate the influence of carotid endarterectomy (CEA) on cerebral perfusion and cognitive function in patients with internal carotid artery stenosis (ICA).
Patients were prospectively enrolled in this study. Shunted patients were excluded. Cerebral perfusion was measured by magnetic resonance (MR) perfusion weighted imaging (PWI) and diffusion weighted imaging (DWI) in 46 patients with >65% ICA (31 males, 64.5 ± 6.7 years) 1 week before and 6 weeks after CEA. Cognitive function was assessed using the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) 1 week before and 6 weeks after CEA.
After CEA, perfusion parameters from PWI decreased, including mean transit time (MTT) (21.07 ± 7.36 vs. 14.27 ± 6.22, p < .0001), time to peak (TTP) (28.69 ± 8.54 vs. 23.45 ± 4.25, p = .001), arrive time (T0) (19.89 ± 7.32 vs. 15.20 ± 3.51, p = .001), and relative cerebral blood volume (rCBV) (11.48 ± 3.50 vs. 7.53 ± 3.17, p < .0001). A significant improvement was observed in MoCA (20.48 ± 1.70 vs. 22.04 ± 1.48, p = .001). Spearman's rank correlation analysis between TTP and MoCA scores demonstrated a linear relationship with an excellent correlation coefficient (R = -.893, p < .001). Linear regression indicated that diabetes was a risk factor for cognitive improvement in patients with ICA (p = .014). Further analysis showed that patients with DM performed worse in MoCA after the procedure (with-DM 21.15 ± 1.28 vs. non-DM 22.4 ± 1.46, p = .010) while the baselines were similar (non-DM: 20.3 ± 1.8 vs. with-DM: 20.9 ± 1.4, p = .362).
CEA could improve the cerebral perfusion and the cognitive function in un-shunted ICA patients. Cerebral reperfusion was an important factor for cognitive improvement. Diabetes had a negative effect on cognitive improvement after CEA.
探讨颈动脉内膜切除术（CEA）对颈内动脉狭窄（ICA）患者脑灌注和认知功能的影响。
前瞻性纳入了 46 名 ICA ＞65%的患者（31 名男性，64.5±6.7 岁），这些患者均未进行分流术。在 CEA 前 1 周和后 6 周，通过磁共振灌注加权成像（PWI）和弥散加权成像（DWI）测量脑灌注。CEA 前 1 周和后 6 周，使用简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）评估认知功能。
CEA 后，PWI 的灌注参数降低，包括平均通过时间（MTT）（21.07±7.36 比 14.27±6.22，p＜0.0001）、达峰时间（TTP）（28.69±8.54 比 23.45±4.25，p=0.001）、到达时间（T0）（19.89±7.32 比 15.20±3.51，p=0.001）和相对脑血容量（rCBV）（11.48±3.50 比 7.53±3.17，p＜0.0001）。MoCA 显著改善（20.48±1.70 比 22.04±1.48，p=0.001）。Spearman 等级相关分析显示 TTP 与 MoCA 评分之间存在线性关系，相关系数很好（R=-0.893，p＜0.001）。线性回归分析表明，糖尿病是 ICA 患者认知改善的危险因素（p=0.014）。进一步分析显示，糖尿病患者术后 MoCA 评分更差（有糖尿病患者 21.15±1.28 比无糖尿病患者 22.4±1.46，p=0.010），而基线相似（无糖尿病患者 20.3±1.8 比有糖尿病患者 20.9±1.4，p=0.362）。
CEA 可改善未分流 ICA 患者的脑灌注和认知功能。脑再灌注是认知改善的重要因素。糖尿病对 CEA 后认知改善有负面影响。
