Department of Surgery, University of Arizona, Tucson, AZ.
Department of Biomedical Engineering, University of Arizona, Tucson, AZ.
Ann Surg. 2022 Sep 1;276(3):539-544. doi: 10.1097/SLA.0000000000005555. Epub 2022 Jun 27.
Carotid revascularization procedures are effective in stroke prevention in appropriately selected patients. We sought to understand the effects of the carotid intervention on cognitive function in a well-defined cohort of prospectively recruited patients.
A total of 170 consecutive patients undergoing carotid intervention for severe carotid stenosis were recruited. Patients received neuropsychometric testing preintervention, and at 1, 6, and 12 months postoperative. Patients were screened with the Mini-Mental State Examination. Rey Auditory Verbal Learning test (RAVLT) test was the primary outcome measure and multiple cognitive tests were used to evaluate executive function. Paired t test and McNemar test were performed to compare age-adjusted and education-adjusted postoperative scores at the individual time point with the preoperative scores.
Our patients had a high prevalence of cardiovascular risks and 51.2% of whom were symptomatic. The usages of statin and antiplatelet were high (88.8% and 69.4%, respectively). A total of 140 patients had 1 or more postoperative neuropsychometric tests in addition to their preoperative tests were included. The average RAVLT preoperative score was lower ( z =-0.79, SD=1.3, confidence interval: -1 to -0.53) than the age-adjusted norm. We observed a significant improvement in RAVLT memory scores at 1 and 6 months postoperative compared with preoperative. We also observed significant improvement in multiple executive functions measures up to 12 months postoperative. The improvement on patients with preoperative stroke symptoms was less consistent.
This prospective study showed that carotid intervention improved memory and executive function in patients with the severe carotid occlusive disease. It highlights the cognitive benefit of the carotid intervention in appropriately selected patients.
颈动脉血运重建术在适当选择的患者中可有效预防卒中。我们旨在通过前瞻性招募的患者队列来了解颈动脉干预对认知功能的影响。
共招募了 170 例因严重颈动脉狭窄而行颈动脉介入治疗的连续患者。患者在术前、术后 1、6 和 12 个月接受神经心理测试。患者接受了简易精神状态检查（MMSE）的筛查。瑞文听觉词汇学习测试（RAVLT）是主要的观察指标，采用多种认知测试来评估执行功能。采用配对 t 检验和 McNemar 检验比较个体时间点的年龄调整和教育调整术后评分与术前评分。
我们的患者有较高的心血管风险，其中 51.2%有症状。他汀类药物和抗血小板药物的使用率较高（分别为 88.8%和 69.4%）。共有 140 例患者除了术前测试外，还进行了 1 次或更多次术后神经心理测试。RAVLT 术前平均得分较低（ z =-0.79，SD=1.3，置信区间：-1 至-0.53），低于年龄调整后的正常值。与术前相比，术后 1 个月和 6 个月时，RAVLT 记忆评分显著提高。我们还观察到，直到术后 12 个月，多个执行功能测量均有显著改善。而术前有卒中症状的患者的改善并不一致。
这项前瞻性研究表明，颈动脉介入治疗可改善严重颈动脉闭塞性疾病患者的记忆和执行功能。它突出了颈动脉干预在适当选择的患者中的认知获益。
