Effects of carotid endarterectomy on cerebral blood flow and neuropsychological test performance in patients with high-grade carotid stenosis
Effects of carotid endarterectomy on cerebral blood flow and neuropsychological test performance in patients with high-grade carotid stenosis
复制标题
DOI：
10.1016/s0022-510x(03)00128-x
复制
发表时间：
2003-09-15
影响因子：
4.4
通讯作者：
Iida, M
中科院分区：
文献类型：
--
作者：
Kishikawa, K;Kamouchi, M;Iida, M
我们检查了高度颈动脉狭窄患者颈动脉内膜切除术（CEA）后认知功能的变化与脑血流量（CBF）的关系。受试者包括 23 名接受 CEA 的患者和 17 名年龄和教育程度匹配的对照者。所有患者在 CEA 前 2 周和 CEA 后 4 周进行单光子发射计算机断层扫描 (SPECT) 和神经心理学测试。术前CBF测试显示9名患者同侧大脑半球血管舒张储备减少，CEA后增加。这些患者的颈动脉狭窄程度显着高于灌注储备正常的患者（分别为 90.2 +/- 8.1% 和 78.6 +/- 11.3%，p < 0.05）。患者组术后简易精神状态检查（MMSE）评分（27.2 +/- 2.9）较术前显着改善（26.1 +/- 3.2，p < 0.05）。此外，CEA术后区组设计测试的得分（86.8 +/- 19.8）显着高于手术前（81.8 +/- 22.3，p < 0.0 1）。 CEA 后立即保留的错误分数从 9.0 +/- 3.1 改善到 7.7 +/- 4.0 (p < 0.05)。在对照组中，第一次和第二次测试之间的测试成绩均未显示出显着改善。在血管舒张储备受损的患者中，与未受损的患者相比，CEA 后区组设计测试的平均评分从 65.6 +/- 22.1 显着改善至 74.0 +/- 19.2 (p < 0.05)。由此得出结论，高度颈动脉狭窄会因脑血流动力学衰竭而导致认知障碍，而 CEA 可能会逆转这种情况。 (C) 2003 Elsevier Science B.V 保留所有权利。
We examined the changes in cognitive function following carotid endarterectomy (CEA) in relation to the cerebral blood flow (CBF) in patients with high-grade carotid stenosis. The subjects consisted of 23 patients who underwent CEA and 17 controls matched by age and education. Single photon emission computed tomography (SPECT) and neuropsychological tests were performed 2 weeks before and 4 weeks after CEA in all patients. The preoperative CBF tests revealed a decreased vasodilatory reserve in the ipsilateral cerebral hemisphere in nine patients, which was increased after CEA. In these patients, the grade of carotid stenosis was significantly higher than in those with a normal perfusion reserve (90.2 +/- 8.1% vs. 78.6 +/- 11.3%, respectively, p < 0.05). In the patient group, the postoperative scores (27.2 +/- 2.9) of the mini-mental state examination (MMSE) improved significantly over the preoperative ones (26.1 +/- 3.2, p < 0.05). Moreover, the scores in the block-design test after CEA (86.8 +/- 19.8) were significantly higher than those before the operation (81.8 +/- 22.3, p < 0.0 1). The error score in immediate retention improved from 9.0 +/- 3.1 to 7.7 +/- 4.0 following CEA (p < 0.05). In the control group, none of the test scores showed significant improvement between the first and second tests. In the patients with an impaired vasodilatory reserve, the mean score of the block-design test significantly improved from 65.6 +/- 22.1 to 74.0 +/- 19.2 after CEA compared with those in patients without impairment (p < 0.05). High-grade carotid stenosis was thus concluded to cause cognitive impairment due to cerebral hemodynamic failure, which is presumably reversed by CEA. (C) 2003 Elsevier Science B.V All rights reserved.