From the Departments of *Internal Medicine, †Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei; ‡Graduate Institute of Oncology, National Taiwan University, Taipei; §Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei; ∥Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City; ¶Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei; #Department of Cardiology, Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City; **National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China.
Clin Nucl Med. 2015 Sep;40(9):701-7. doi: 10.1097/RLU.0000000000000880.
Neurocognitive performance among patients with carotid artery stenosis or occlusion may deteriorate because of chronic cerebral hypoperfusion. Carotid artery stenting (CAS) has been reported to improve cerebral perfusion and neurocognitive function. The purpose of the study was to evaluate cerebral metabolism using F-fluorodeoxyglucose (FDG) positron emission tomography (PET) after CAS.
Nineteen consecutive patients (15 men, 69 ± 13 years) with carotid artery stenosis or occlusion and cerebral ischemia detected on brain perfusion computed tomography (CT) or magnetic resonance imaging (MRI) were enrolled. Four patients had bilateral lesions, and 15 subjects had previous ischemic stroke. Neurocognitive function (NCF) assessments and brain FDG PET scans were performed before and 19 ± 7 (12-31) months after the procedure.
The procedural success rate of CAS was 70%. Two patients were excluded from the study because of procedural complications. No new cerebral ischemic events or neurologic deaths occurred during follow-up of 44 ± 11 (15-54) months. Significant improvements were observed in the Mini-Mental State Examination (before, 26.06 ± 3.32 versus after, 28.13 ± 2.8; P = 0.0016), the verbal fluency test (26.81 ± 7.82 versus 30.75 ± 9.58; P = 0.0378), and marginal upgrading in the Alzheimer Disease Assessment Scale-Cognitive Subtest (7.19 ± 7.59 versus 5.63 ± 5.90; P = 0.0523). Six of 9 patients who underwent successful CAS showed improvement of cerebral glucose metabolism. Of the 4 patients with recanalization failure, 2 exhibited decline in ipsilateral glucose metabolism. Cerebral FDG metabolism improved in patients with successful CAS (P = 0.038), although there was a weak correlation between interval change of NCF tests and brain FDG metabolism.
Successful CAS may improve long-term cerebral glucose metabolism and neurocognitive function in patients with chronic severe carotid stenosis or occlusion.
颈动脉狭窄或闭塞患者的神经认知表现可能因慢性脑灌注不足而恶化。已有报道称颈动脉支架置入术（CAS）可改善脑灌注和神经认知功能。本研究旨在通过氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）评估 CAS 后的脑代谢情况。
19 例连续的颈动脉狭窄或闭塞患者（15 例男性，69±13 岁）和脑灌注计算机断层扫描（CT）或磁共振成像（MRI）检测到的脑缺血患者入选。其中 4 例为双侧病变，15 例患者有既往缺血性卒中。神经认知功能（NCF）评估和脑 FDG PET 扫描在术前和术后 19±7（12-31）个月进行。
CAS 的手术成功率为 70%。2 例患者因手术并发症被排除在研究之外。在 44±11（15-54）个月的随访期间，无新发脑缺血事件或神经死亡发生。在简易精神状态检查（术前 26.06±3.32 分，术后 28.13±2.8 分；P=0.0016）、言语流畅性测试（术前 26.81±7.82 分，术后 30.75±9.58 分；P=0.0378）和阿尔茨海默病评估量表认知子测验（7.19±7.59 分，术后 5.63±5.90 分；P=0.0523）方面均有显著改善。9 例成功接受 CAS 的患者中有 6 例脑葡萄糖代谢得到改善。4 例再通失败的患者中，有 2 例同侧葡萄糖代谢下降。成功接受 CAS 的患者脑 FDG 代谢得到改善（P=0.038），尽管 NCF 测试的间隔变化与脑 FDG 代谢之间存在弱相关性。
成功的 CAS 可能改善慢性严重颈动脉狭窄或闭塞患者的长期脑葡萄糖代谢和神经认知功能。
