Foret Thomas, Guillaumin Michel, Desmarets Maxime, Costa Patricia, Rinckenbach Simon, du Mont Lucie Salomon
Vascular Medicine Unit, Vascular and Endovascular Surgery Department, CHRU Besançon, France.
Geriatric Department, CHRU Besançon, France.
Vasa. 2022 May;51(3):138-149. doi: 10.1024/0301-1526/a000996. Epub 2022 Mar 21.
Asymptomatic carotid stenosis (ACS) can cause cognitive dysfunction, related to cerebral hypoperfusion and microemboli. These mechanisms could be treated by carotid revascularization, but the impact of carotid angioplasty stenting (CAS) or carotid endarterectomy (CEA) on cognitive functions remains unclear. The aim of this systematic review was to realize a report on the actual state of results about asymptomatic carotid stenosis revascularization and cognitive function. We performed a systematic literature review to analyze all studies assessing the impact of asymptomatic carotid stenosis revascularizations on cognitive functions. We reviewed all publications published in Medline database and Cochrane between January 2010 and January 2020 including subjects with a cognitive evaluation and receiving carotid revascularization for asymptomatic stenosis. We identified 567 records for review, and finally we included in the systematic review 20 studies about ACS revascularization and cognitive functions. Only observational studies analyzed the impact of CEA and CAS on cognitive functions. Thus, too heterogeneous data associated to the lack of randomized controlled trials with an evaluation of optimal medical treatment did not enable to affirm the interest of the revascularization management of ACS in cognitive domain. There was a lack of standardization and finally studies were too heterogeneous to conclude on the impact of carotid revascularization on cognitive functions. There is an urgent need to harmonize research in this domain in order to prevent and treat cognitive dysfunction related to ACS, especially in our society with an aging population.
无症状性颈动脉狭窄（ACS）可导致认知功能障碍，与脑灌注不足和微栓子有关。这些机制可通过颈动脉血运重建来治疗，但颈动脉血管成形术支架置入术（CAS）或颈动脉内膜切除术（CEA）对认知功能的影响仍不明确。本系统评价的目的是报告无症状性颈动脉狭窄血运重建与认知功能的实际研究结果。我们进行了一项系统的文献综述，以分析所有评估无症状性颈动脉狭窄血运重建对认知功能影响的研究。我们检索了2010年1月至2020年1月期间发表在Medline数据库和Cochrane上的所有出版物，纳入了有认知评估且因无症状性狭窄接受颈动脉血运重建的受试者。我们确定了567条记录进行综述，最终在系统评价中纳入了20项关于ACS血运重建与认知功能的研究。只有观察性研究分析了CEA和CAS对认知功能的影响。因此，由于缺乏评估最佳药物治疗的随机对照试验，相关数据过于异质，无法肯定ACS血运重建治疗在认知领域的益处。缺乏标准化，最终研究过于异质，无法就颈动脉血运重建对认知功能的影响得出结论。迫切需要统一该领域的研究，以预防和治疗与ACS相关的认知功能障碍，尤其是在我们这个人口老龄化的社会中。
