Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Wisconsin Surgical Outcomes Center Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Neurosurgery. 2018 Mar 1;82(3):322-328. doi: 10.1093/neuros/nyx173.
Vascular cognitive decline is critically important in the course of atherosclerosis and stroke.
To explore the hypothesis that carotid endarterectomy (CEA) by removing an unstable plaque may slow the course of vascular cognitive decline in both symptomatic and asymptomatic patients.
Patients with clinically significant (>60%) carotid stenosis were studied preop and 1 yr post-CEA for clinical symptoms, vascular cognitive decline, instability of carotid plaque-presence of microemboli, brain white matter changes, and medical risk factors.
Forty-six percent were classically symptomatic. All patients showed vascular cognitive decline at presentation which correlated with degree of plaque instability. Significant white matter hyperintensity changes (48.7%) and cerebral emboli (25%) were also seen at baseline in both classically symptomatic and asymptomatic. One year after CEA, both groups showed no decline in cognitive function and significant improvement in 2 tests (P = .028 and P = .013). Brain white matter hyperintensities were unchanged. Microemboli were reduced but remained present (17.86%). Improvement was predicted by the presence of hypertension (P = .001), or less advanced cognitive decline preoperatively (P = .009).
This study demonstrates the importance of vascular cognitive decline in atherosclerotic disease. This is a function of the degree of instability of the atherosclerotic plaque more than the presence of stroke symptoms. It further suggests that atherosclerotic vascular cognitive decline need not be inevitable, and may be modified by treating hypertension and removal of the unstable plaque. This highlights the need for continued research on the cognitive effects of cerebrovascular disease and the synergistic benefits of intensive medical and surgical therapy.
血管性认知衰退在动脉粥样硬化和中风的病程中至关重要。
探讨颈动脉内膜切除术（CEA）切除不稳定斑块是否可以减缓有症状和无症状患者血管性认知衰退进程的假说。
研究了有临床意义（>60%）颈动脉狭窄的患者，在术前和 CEA 后 1 年进行临床症状、血管性认知衰退、颈动脉斑块不稳定性-微栓子的存在、脑白质变化和医疗风险因素的研究。
46%的患者为经典有症状。所有患者在出现时均表现出血管性认知衰退，与斑块不稳定性程度相关。在经典有症状和无症状患者中，基线时也发现了明显的脑白质高信号变化（48.7%）和脑栓塞（25%）。CEA 后 1 年，两组的认知功能均无下降，2 项测试有显著改善（P =.028 和 P =.013）。脑白质高信号无变化。微栓子减少，但仍存在（17.86%）。改善与高血压的存在（P =.001）或术前认知衰退程度较轻（P =.009）有关。
本研究表明血管性认知衰退在动脉粥样硬化疾病中很重要。这是动脉粥样硬化斑块不稳定性程度的作用，而不是中风症状的存在。它进一步表明，动脉粥样硬化性血管性认知衰退并非不可避免，通过治疗高血压和切除不稳定斑块可能会得到改善。这凸显了需要对脑血管疾病的认知影响以及强化医疗和手术治疗的协同益处进行持续研究。
