Cognitive outcome after EC-IC bypass surgery in hemodynamic cerebral ischemia
Cognitive outcome after EC-IC bypass surgery in hemodynamic cerebral ischemia
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DOI：
10.1007/s00701-011-0949-x
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发表时间：
2011-06-01
影响因子：
2.4
通讯作者：
Polakova, Simona
中科院分区：
文献类型：
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作者：
Fiedler, Jiri;Priban, Vladimir;Polakova, Simona
目的评价脑缺血行颅内外搭桥手术患者的认知功能。人群与方法2003年8月至2009年1月对276例颈内动脉闭塞患者进行筛查。其中40个符合低流量EC-IC旁路的标准。这些患者是根据使用多普勒CO(2)试验和CT灌注的耗尽血管舒缩反应性（VMR）证据来确定的。这些患者被邀请在术前和术后12个月进行完整的神经心理测试。20例患者完成了完整的神经认知测试。结果本组20例患者术前均出现轻度至中重度认知功能障碍。随访期间无手术侧同侧脑卒中病例。手术后6个月内，所有患者的VMR均有改善。采用配对t检验的比较显示，术后12个月在以下神经心理测试中有显著改善：WAIS-R （p = 0.01）、号码收集测试（p = 0.02）、径迹制作测试（p = 0.03）和Benton视觉保留测试（p = 0.05）。重复方差分析（ANOVA）提示以下预测因素与认知改善相关：眼侧支血流的存在（p = 0.04），术前模糊黑朦（p = 0.02）， MRI检测外分水岭梗死（p = 0.04）。结论颈间动脉闭塞和VMR衰竭患者在颈间动脉搭桥手术前存在认知障碍。手术后12个月，患者在各个认知领域都有显著改善。
Objective The purpose of this study was to evaluate cognitive functions in patients undergoing extracranial-intracranial (EC-IC) bypass surgery for cerebral ischemia.Population and methods From August 2003 to January 2009, 276 patients with occluded internal carotid arteries (ICA) were screened. Forty of these met the criteria for a low-flow EC-IC bypass. These patients were identified based on evidence of exhausted vasomotor reactivity (VMR) using the Doppler CO(2) test and CT perfusion. These patients were invited to have a complete battery of neuropsychological tests preoperatively and 12 months after surgery. Complete neurocognitive testing was finished in 20 patients.Results This group of 20 patients showed preoperative cognitive impairment ranging from mild to medium-severe. There were no cases of stroke ipsilateral to the operated side during the follow-up period. VMR improvement was seen in all patients within 6 months of surgery. A comparison using a paired t-test demonstrated significant improvement 12 months after surgery in the following neuropsychological tests: WAIS-R (p = 0.01), Number Collection Test (p = 0.02), Trail Making Test (p = 0.03), and Benton Visual Retention Test (p = 0.05). Repeat analysis of variance (ANOVA) suggested the following predictors associated with cognitive improvement:the presence of ophthalmic collateral flow (p = 0.04), preoperative amaurosis fugax (p = 0.02), and external watershed infarction detected by MRI (p = 0.04).Conclusion Patients with occlusion of the ICA and exhausted VMR have cognitive impairment prior to EC-IC bypass surgery. Twelve months after surgery, there is significant improvement in various areas of cognition.