Departments of1Neurosurgery and.
2Anesthesiology, Kobe University Graduate School of Medicine, Kobe, Japan.
J Neurosurg. 2023 Mar 10;139(4):1010-1017. doi: 10.3171/2023.1.JNS222804. Print 2023 Oct 1.
Carotid stenosis can lead to both cognitive impairment (CI) and ischemic stroke. Although carotid revascularization surgery, which includes carotid endarterectomy (CEA) and carotid artery stenting (CAS), can prevent future strokes, its effect on cognitive function is controversial. In this study, the authors examined resting-state functional connectivity (FC) in carotid stenosis patients with CI undergoing revascularization surgery, with a particular focus on the default mode network (DMN).
Twenty-seven patients with carotid stenosis who were scheduled to undergo CEA or CAS between April 2016 and December 2020 were prospectively enrolled. A cognitive assessment, including the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Japanese version of the Montreal Cognitive Assessment (MoCA), as well as resting-state functional MRI, was performed 1 week preoperatively and 3 months postoperatively. For FC analysis, a seed was placed in the region associated with the DMN. The patients were divided into two groups according to the preoperative MoCA score: a normal cognition (NC) group (MoCA score ≥ 26) and a CI group (MoCA score < 26). The difference in cognitive function and FC between the NC and CI groups was investigated first, and then the change in cognitive function and FC after carotid revascularization was investigated in the CI group.
There were 11 and 16 patients in the NC and CI groups, respectively. The FC of the medial prefrontal cortex with the precuneus and that of the left lateral parietal cortex (LLP) with the right cerebellum were significantly lower in the CI group than in the NC group. In the CI group, significant improvements were found in MMSE (25.3 vs 26.8, p = 0.02), FAB (14.4 vs 15.6, p = 0.01), and MoCA scores (20.1 vs 23.9, p = 0.0001) after revascularization surgery. Significantly increased FC of the LLP with the right intracalcarine cortex, right lingual gyrus, and precuneus was observed after carotid revascularization. In addition, there was a significant positive correlation between the increased FC of the LLP with the precuneus and improvement in the MoCA score after carotid revascularization.
These findings suggest that carotid revascularization, including CEA and CAS, might improve cognitive function based on brain FC in the DMN in carotid stenosis patients with CI.
颈动脉狭窄可导致认知障碍（CI）和缺血性中风。虽然包括颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）在内的颈动脉血运重建术可以预防未来的中风，但它对认知功能的影响仍存在争议。在这项研究中，作者研究了接受血运重建术的伴有 CI 的颈动脉狭窄患者的静息状态功能连接（FC），特别关注默认模式网络（DMN）。
前瞻性纳入 2016 年 4 月至 2020 年 12 月期间计划行 CEA 或 CAS 的 27 例颈动脉狭窄患者。在术前 1 周和术后 3 个月进行认知评估，包括简易精神状态检查（MMSE）、额叶评估量表（FAB）和蒙特利尔认知评估的日本版（MoCA）以及静息状态功能磁共振成像。对于 FC 分析，将种子置于与 DMN 相关的区域。根据术前 MoCA 评分将患者分为正常认知（NC）组（MoCA 评分≥26）和 CI 组（MoCA 评分<26）。首先比较 NC 组和 CI 组之间认知功能和 FC 的差异，然后研究 CI 组颈动脉血运重建后认知功能和 FC 的变化。
NC 组和 CI 组分别有 11 例和 16 例患者。CI 组内侧前额叶皮质与楔前叶之间以及左侧顶下小叶（LLP）与右侧小脑之间的 FC 明显低于 NC 组。CI 组患者术后 MMSE（25.3 比 26.8，p=0.02）、FAB（14.4 比 15.6，p=0.01）和 MoCA 评分（20.1 比 23.9，p=0.0001）显著改善。颈动脉血运重建后，观察到 LLP 与右距状裂皮质、右舌回和楔前叶之间的 FC 显著增加。此外，颈动脉血运重建后 LLP 与楔前叶之间 FC 的增加与 MoCA 评分的改善呈显著正相关。
这些发现表明，包括 CEA 和 CAS 在内的颈动脉血运重建术可能会改善伴有 CI 的颈动脉狭窄患者的认知功能，其依据是 DMN 中的脑 FC。
