Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Department of Neurosurgery, Peking University International Hospital, Beijing 102206, China.
Neural Plast. 2020 Sep 23;2020:9345602. doi: 10.1155/2020/9345602. eCollection 2020.
Asymptomatic carotid artery stenosis (CAS) and occlusion (CAO) disrupt cerebral hemodynamics. There are few studies on the brain network changes and compensation associated with the progression from chronic CAS to CAO. In the current study, our goal is to improve the understanding of the specific abnormalities and compensatory phenomena associated with the functional connection in patients with CAS and CAO. In this prospective study, 27 patients with CAO, 29 patients with CAS, and 15 healthy controls matched for age, sex, education, handedness, and risk factors underwent neuropsychological testing and resting-state functional magnetic resonance (rs-fMRI) imaging simultaneously; graph theoretical analysis of brain networks was performed to determine the relationship between changes in brain network connectivity and the progression from internal CAS to CAO. The global properties of the brain network assortativity ( = 0.002), hierarchy ( = 0.002), network efficiency ( = 0.011), and small-worldness ( = 0.009) were significantly more abnormal in the CAS group than in the control and CAO groups. In patients with CAS and CAO, the nodal efficiency of key nodes in multiple brain regions decreased, while the affected hemisphere lost many key functional connections. In this study, we found that patients with CAS showed grade reconstruction, invalid connections, and other phenomena that impaired the efficiency of information transmission in the brain network. A compensatory functional connection in the contralateral cerebral hemisphere of patients with CAS and CAO may be an important mechanism that maintains clinical asymptomatic performance. This study not only reveals the compensation mechanism of cerebral hemisphere ischemia but also validates previous explanations for brain function connectivity, which can help provide interventions in advance and reduce the impairment of higher brain functions. This trial is registered with Clinical Trial Registration-URL http://www.chictr.org.cn and Unique identifier ChiCTR1900023610.
无症状性颈动脉狭窄（CAS）和闭塞（CAO）会破坏脑血流动力学。关于从慢性 CAS 进展为 CAO 时相关的脑网络变化和代偿作用的研究较少。在目前的研究中，我们的目标是提高对慢性 CAS 和 CAO 患者功能连接相关的特定异常和代偿现象的认识。在这项前瞻性研究中，27 例 CAO 患者、29 例 CAS 患者和 15 名年龄、性别、教育程度、利手和危险因素相匹配的健康对照者同时接受神经心理学测试和静息态功能磁共振（rs-fMRI）成像；对脑网络进行图论分析，以确定脑网络连接变化与从内部 CAS 进展为 CAO 的关系。脑网络全局属性的聚类系数（ = 0.002）、层次（ = 0.002）、网络效率（ = 0.011）和小世界属性（ = 0.009）在 CAS 组中明显比对照组和 CAO 组更异常。在 CAS 和 CAO 患者中，多个脑区关键节点的节点效率降低，而受影响的半球失去了许多关键的功能连接。在这项研究中，我们发现 CAS 患者表现出网络重构、无效连接等现象，这些现象会损害脑网络中信息传递的效率。CAS 和 CAO 患者对侧大脑半球的代偿性功能连接可能是维持临床无症状表现的重要机制。本研究不仅揭示了大脑半球缺血的代偿机制，还验证了先前对脑功能连接的解释，可以帮助提前进行干预，减少对更高脑功能的损害。本试验已在临床试验注册网站（http://www.chictr.org.cn）注册，注册号为 ChiCTR1900023610。
