Sklinda Katarzyna, Mruk Bartosz, Surowiecka Agnieszka, Ciaś Marek, Paluch Łukasz, Andziak Piotr, Walecki Jerzy
Department of Diagnostic and Interventional Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland.
Department of Surgical Research and Transplantology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.
Med Sci Monit. 2020 Dec 30;26:e927029. doi: 10.12659/MSM.927029.
BACKGROUND The relative efficacy of carotid endarterectomy (CEA)/thromboendarterectomy (TEA) and carotid artery stenting (CAS) already has been compared in randomized controlled trials and a meta-analysis, but only limited data exist describing the status of cerebral metabolism before and after these interventions. The aim of the present study was to compare metabolic changes before and after treatment of carotid stenosis and assess their potential clinical implications. MATERIAL AND METHODS Patients with asymptomatic unilateral critical internal CAS were imaged with proton 3T magnetic resonance spectroscopy (H-MRS) because the technique is more sensitive than regular magnetic resonance imaging for detection of the early signs of ischemic events. Abnormal metabolite ratios detected with H-MRS may precede actual morphological changes associated with hypoperfusion as well as reperfusion changes. Ipsilateral and contralateral middle cerebral artery vascular territories were both evaluated before and after vascular intervention. H-MRS was performed within 24 h before and after surgery. Correlations in the metabolic data from H-MRS for N-acetylaspartic acid (NAA)+N-acetylaspartylglutamate, creatinine (Cr)+phosphocreatinine, and phosphocholine+glycerophosphocholine (Cho) were sought. RESULTS H-MRS voxels from 11 subjects were analyzed. Values for dCho/CrI, dCho/CrC and Cho/Naal (P<0.001) were significantly higher ipsilaterally than contralaterally. Ratios for dNaa/ChoC and Cho/NaaC were significantly higher on the non-operated side (P<0.001). CONCLUSIONS H-MRS may be helpful for assessment of patients with CAS, particularly because unlike other modalities, it reveals postoperative changes in metabolic brain status. Initial results indicate the important role of perioperative neuroprotective treatment.
颈动脉内膜切除术（CEA）/血栓内膜切除术（TEA）与颈动脉支架置入术（CAS）的相对疗效已在随机对照试验和一项荟萃分析中进行了比较，但描述这些干预前后脑代谢状态的数据有限。本研究的目的是比较颈动脉狭窄治疗前后的代谢变化，并评估其潜在的临床意义。
对无症状单侧严重颈内动脉狭窄患者进行质子3T磁共振波谱成像（H-MRS），因为该技术在检测缺血事件早期迹象方面比常规磁共振成像更敏感。H-MRS检测到的异常代谢物比率可能先于与低灌注以及再灌注变化相关的实际形态学改变。在血管干预前后均对同侧和对侧大脑中动脉血管区域进行评估。H-MRS在手术前后24小时内进行。寻找H-MRS代谢数据中N-乙酰天门冬氨酸（NAA）+N-乙酰天门冬氨酰谷氨酸、肌酸（Cr）+磷酸肌酸以及磷酸胆碱+甘油磷酸胆碱（Cho）之间的相关性。
分析了11名受试者的H-MRS体素。同侧的dCho/CrI、dCho/CrC和Cho/Naal值（P<0.001）显著高于对侧。非手术侧的dNaa/ChoC和Cho/NaaC比率显著更高（P<0.001）。
H-MRS可能有助于评估CAS患者，特别是因为与其他方式不同，它揭示了术后脑代谢状态的变化。初步结果表明围手术期神经保护治疗的重要作用。
