Department of Biomedical Engineering, University of Arizona, Tucson, Arizona 85721, United States.
Department of Surgery, University of Arizona, Tucson, Arizona 85721, United States.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107926. doi: 10.1016/j.jstrokecerebrovasdis.2024.107926. Epub 2024 Aug 16.
A growing body of data indicates that extracranial carotid artery disease (ECAD) can contribute to cognitive impairment. However, there have been mixed reports regarding the benefit of carotid endarterectomy (CEA) as it relates to preserving cognitive function. In this work, diffusion magnetic resonance imaging (dMRI) and neurocognitive testing are used to provide insight into structural and functional brain changes that occur in subjects with significant carotid artery stenosis, as well as changes that occur in response to CEA.
The study design was a prospective, non-randomized, controlled study that enrolled patients with asymptomatic carotid stenosis. Thirteen subjects had severe ECAD (≥70% stenosis in at least one carotid artery) and were scheduled to undergo surgery. Thirteen had asymptomatic ECAD with <70% stenosis, therefore not requiring surgery. All subjects underwent neurocognitive testing using the Montreal Cognitive Assessment test (MoCA) and high angular resolution, multi-shell diffusion magnetic resonance imaging (dMRI) of the brain at baseline and at four-six months follow-up. Changes in MoCA scores as well as in Fractional anisotropy (FA) along the hippocampus were compared at baseline and follow-up.
At baseline, FA was significantly lower along the ipsilateral hippocampus in subjects with severe ECAD compared to subjects without severe ECAD. MoCA scores were lower in these individuals, but this did not reach statistical significance. At follow-up, MoCA scores increased significantly in subjects who underwent CEA and remained statistically equal in control subjects that did not have CEA. FA remained unchanged in the CEA group and decreased in the control group.
This study suggests that CEA improves cognition and preserves hippocampal white matter structure compared to control subjects not undergoing CEA.
越来越多的数据表明，颅外颈动脉疾病（ECAD）可导致认知障碍。然而，关于颈动脉内膜切除术（CEA）在保护认知功能方面的益处，一直存在着不同的报告。在这项工作中，弥散磁共振成像（dMRI）和神经认知测试用于提供有关发生在颈动脉狭窄明显的受试者中的结构和功能脑变化的深入了解，以及发生在对 CEA 反应中的变化。
研究设计是一项前瞻性、非随机、对照研究，招募了无症状颈动脉狭窄的患者。13 名患者患有严重的 ECAD（至少一条颈动脉的狭窄程度≥70%），并计划接受手术。13 名患者患有无症状的 ECAD，狭窄程度<70%，因此不需要手术。所有受试者均接受神经认知测试，使用蒙特利尔认知评估测试（MoCA）和大脑的高角度分辨率、多壳弥散磁共振成像（dMRI），在基线和随访的四至六个月时进行。在基线和随访时，比较 MoCA 评分以及沿着海马体的分数各向异性（FA）的变化。
在基线时，与无严重 ECAD 的受试者相比，严重 ECAD 患者的同侧海马体的 FA 值显著降低。这些患者的 MoCA 评分较低，但这并没有达到统计学意义。在随访时，接受 CEA 的患者的 MoCA 评分显著增加，而未接受 CEA 的对照组患者的 MoCA 评分保持统计学相等。CEA 组的 FA 保持不变，而对照组的 FA 下降。
与未接受 CEA 的对照组相比，CEA 可改善认知功能并保留海马体白质结构。
