Jurga Juliane, Tornvall Per, Dey Linda, van der Linden Jan, Sarkar Nondita, von Euler Mia
Unit of Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Am J Cardiol. 2016 Nov 15;118(10):1437-1441. doi: 10.1016/j.amjcard.2016.08.003. Epub 2016 Aug 24.
Cerebral microemboli are frequently observed during coronary angiography (CA) and percutaneous coronary intervention (PCI), and their numbers have been related to the vascular access site used. Although cerebral microemboli can cause silent cerebral lesions, their clinical impact is debated. To study this, 93 patients referred for CA or PCI underwent serial cognitive testing using the Montreal Cognitive Assessment (MoCA) test to detect postprocedural cognitive impairment. Patients were randomized to radial or femoral access. In a subgroup of 35 patients, the number of cerebral microemboli was monitored with transcranial Doppler technique. We found the median precatheterization result of the MoCA test to be 27, and it did not change significantly 4 and 31 days, respectively, after the procedure. There was no significant correlation between the number of cerebral microemboli and the difference between preprocedural and postprocedural MoCA tests. The test results did not differ between vascular access sites. One-third of the patients had a precatheterization median MoCA test result <26 corresponding to mild cognitive impairment. In conclusion, using the MoCA test, we could not detect any cognitive impairment after CA or PCI, and no significant correlations were found between the results of the MoCA test and cerebral microemboli or vascular access site, respectively. In patients with suspected coronary heart disease, mild cognitive impairment was common.
在冠状动脉造影（CA）和经皮冠状动脉介入治疗（PCI）期间经常观察到脑微栓子，其数量与所使用的血管入路部位有关。尽管脑微栓子可导致无症状性脑损伤，但其临床影响仍存在争议。为了研究这一问题，93例接受CA或PCI治疗的患者使用蒙特利尔认知评估（MoCA）测试进行了系列认知测试，以检测术后认知障碍。患者被随机分为桡动脉或股动脉入路组。在35例患者的亚组中，采用经颅多普勒技术监测脑微栓子的数量。我们发现MoCA测试的导管插入术前中位数结果为27，术后4天和31天分别没有显著变化。脑微栓子数量与术前和术后MoCA测试结果的差异之间没有显著相关性。不同血管入路部位的测试结果没有差异。三分之一的患者导管插入术前MoCA测试中位数结果<26，对应轻度认知障碍。总之，使用MoCA测试，我们在CA或PCI术后未检测到任何认知障碍，并且MoCA测试结果与脑微栓子或血管入路部位之间分别未发现显著相关性。在疑似冠心病患者中，轻度认知障碍很常见。
