Improved visual, acoustic, and neurocognitive functions after carotid endarterectomy in patients with minor stroke from severe carotid stenosis
Improved visual, acoustic, and neurocognitive functions after carotid endarterectomy in patients with minor stroke from severe carotid stenosis
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严重颈动脉狭窄引起的轻微卒中患者颈动脉内膜切除术后视觉、听觉和神经认知功能得到改善
DOI：
10.1016/j.jvs.2015.04.401
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发表时间：
2015-09-01
影响因子：
4.3
通讯作者：
Jing, Zaiping
中科院分区：
文献类型：
--
作者：
Qu, Lefeng;Feng, Jiaxuan;Jing, Zaiping
目的：颈动脉内膜切除术（CEA）是一种公认的预防中风的手术，但其其他潜在效果，如改善神经认知、视觉和听觉功能，仍未得到证实。本研究考察了CEA对症状性颈动脉狭窄患者的影响。方法：这是一项前瞻性对照研究，包括80例伴有严重颅外颈内动脉狭窄（bbb70 %）的轻微中风患者。40名患者，由于担心年龄、害怕手术、癌症导致的预期寿命有限或经济问题而没有接受CEA或推迟了CEA，组成了药物治疗组。另外40例患者在招募后1周接受CEA，组成CEA组。两组在治疗前和治疗后3个月分别采用视力表测试、视野测试、听力测试和神经系统量表（美国国立卫生研究院卒中量表、迷你精神状态检查和Barthel日常生活活动指数）评估眼功能、听觉灵敏度和神经认知功能。通过组内和组间比较来检验CEA的效果。结果：随访3个月，无死亡或脑卒中发生。同侧功能组内组间比较表明，CEA在250 Hz、500 Hz、1000 Hz、2000 Hz和4000 Hz各测试频率下均能改善视力、视野和听觉，在1000 Hz对侧功能可改善视野和听觉。2000hz和4000hz的听觉敏锐度组内比较无变化，组间比较与药物组比较无下降。组间比较，CEA治疗组的一般神经认知功能和独立生活能力明显改善（美国国立卫生研究所卒中量表变化率：-8.1% +/- 9.0% vs -2.7% +/- 3.0%, P < 0.001；迷你精神状态检查变化率：15.5% +/- 10.5% vs 1.6% +/- 2.6%, P < 0.001； Barthel指数变化率：28.0% +/- 24.6% vs 2.0% +/- 5.5%, P < 0.001）。结论：在颈动脉严重狭窄引起的轻度脑卒中患者中，CEA可改善神经认知功能、眼功能和听功能。需要更大样本和更长随访时间的研究来证实这些结果，潜在的机制需要进一步调查。
Objective: Carotid endarterectomy (CEA) is an established operation performed to prevent strokes, but its other potential effects, such as improving neurocognitive, visual, and auditory functions, remain unconfirmed. This study examined these effects of CEA on patients with symptomatic carotid stenosis.Methods: This was a prospective controlled study that included 80 patients with minor strokes who had severe extracranial internal carotid stenoses (>70%). Forty patients, who did not receive or who postponed the CEA due to concerns about age, fear of surgery, limited life expectancy because of cancer, or financial problems, formed the medicine-treatment group. Another 40 patients who received CEA 1 week after recruitment formed the CEA group. For both groups, visual acuity chart tests, perimetry tests, audiometry tests, and neurologic scales (National Institutes of Health Stroke Scale, Mini Mental State Examination, and Barthel Index of Activities of Daily Living) were used to assess ophthalmic functions, auditory acuity, and neurocognitive functions before treatment and 3 months after treatment. Intragroup and intergroup comparisons were conducted to examine the effect of CEA.Results: No deaths or strokes occurred during the 3-month follow-up. The intragroup and intergroup comparisons of ipsilateral function showed that CEA could improve visual acuity, visual field, and auditory acuity at all tested frequencies (250 Hz, 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz) and could improve the visual field and the auditory acuity for contralateral functions at 1000 Hz. The auditory acuity at 2000 Hz and 4000 Hz were unchanged in the intragroup comparison but showed no deterioration in the intergroup comparison with the medicine group. General neurocognitive function and independent living ability were significantly improved by CEA, as shown by intergroup comparisons (change rate of National Institutes of Health Stroke Scale: -8.1% +/- 9.0% vs -2.7% +/- 3.0%, P < .001; change rate of Mini Mental State Examination: 15.5% +/- 10.5% vs 1.6% +/- 2.6%, P < .001; change rate of Barthel Index: 28.0% +/- 24.6% vs 2.0% +/- 5.5%, P < .001).Conclusions: In patients with minor strokes caused by severe carotid stenosis, CEA improves neurocognitive, ophthalmic, and acoustic functions. Studies with a larger sample and longer follow-up are needed to substantiate these results, and the underlying mechanisms need further investigation.