Chinda Betty, Liang Simon, Siu William, Medvedev George, Song Xiaowei
Health Sciences and Innovation, Surrey Memorial Hospital, Fraser Health Authority, British Columbia, Canada.
Department of Biomedical Physiology & Kinesiology, Simon Fraser University, British Columbia, Canada.
Acta Radiol Open. 2021 Feb 10;10(2):2058460120988822. doi: 10.1177/2058460120988822. eCollection 2021 Feb.
The narrowing of the carotid arteries with plaque formation represents a major risk factor for ischemic stroke and cognitive impairments. Carotid angioplasty and stenting is a standard clinical treatment to reduce stroke risk. The cognitive effect of carotid angioplasty and stenting remains largely unknown.
This study aims to provide direct evidence of possible effects of carotid angioplasty and stenting on cognition, using task-phase functional magnetic resonance imaging.
This study received harmonized institutional ethics board approval (Grant number REB ID =H18-02495/FHREB 2018-058). Two patients had MRI scans pre-carotid angioplasty and stenting and two-month post-carotid angioplasty and stenting. Case 1 had severe (>95%) flow-limiting stenosis in the right carotid artery. Case 2 had 70% non-flow limiting stenosis in the left carotid artery. At each scan, patients completed two functional magnetic resonance imaging sessions while performing a working memory task. Accuracy, reaction time, and brain activation were analyzed for each patient for possible pre-post carotid angioplasty and stenting changes.
Case 1 showed increased activation in the right (treated-side) frontal and temporal lobes post-carotid angioplasty and stenting; associated with improvements in accuracy (from 58% to 74%) and task completion rate (from 17% to 72%). Case 2 completed the tasks pre- and post-carotid angioplasty and stenting with >90% accuracy, while decreased functional magnetic resonance imaging activation in the contralateral (untreated) hemisphere and mildly increased activation in the left (treated -side) anterior circulation territory were observed post-carotid angioplasty and stenting.
These cases provided the first task-phase functional magnetic resonance imaging data demonstrating that carotid angioplasty and stenting improved cognitive function in the re-perfused vascular territory. The finding supports the role of carotid angioplasty and stenting in improving cognitive performance beyond reducing stroke risk.
伴有斑块形成的颈动脉狭窄是缺血性中风和认知障碍的主要危险因素。颈动脉血管成形术和支架置入术是降低中风风险的标准临床治疗方法。颈动脉血管成形术和支架置入术对认知的影响在很大程度上仍不清楚。
本研究旨在使用任务期功能磁共振成像，为颈动脉血管成形术和支架置入术对认知可能产生的影响提供直接证据。
本研究获得了统一的机构伦理委员会批准（批准号REB ID =H18-02495/FHREB 2018-058）。两名患者在颈动脉血管成形术和支架置入术前以及术后两个月进行了磁共振成像扫描。病例1右侧颈动脉存在严重（>95%）的血流限制性狭窄。病例2左侧颈动脉存在70%的非血流限制性狭窄。每次扫描时，患者在执行工作记忆任务的同时完成两次功能磁共振成像检查。分析了每位患者在颈动脉血管成形术和支架置入术前、后的准确性、反应时间和脑激活情况，以观察可能的变化。
病例1在颈动脉血管成形术和支架置入术后，右侧（治疗侧）额叶和颞叶的激活增加；同时准确性（从58%提高到74%）和任务完成率（从17%提高到72%）有所改善。病例2在颈动脉血管成形术和支架置入术前、后均以>90%的准确率完成任务，而在颈动脉血管成形术和支架置入术后，对侧（未治疗）半球的功能磁共振成像激活减少，左侧（治疗侧）前循环区域的激活略有增加。
这些病例提供了首个任务期功能磁共振成像数据，表明颈动脉血管成形术和支架置入术改善了再灌注血管区域的认知功能。这一发现支持了颈动脉血管成形术和支架置入术在改善认知表现方面的作用，而不仅仅是降低中风风险。
