Diffusion-weighted lesions after carotid artery stenting are associated with cognitive impairment
Diffusion-weighted lesions after carotid artery stenting are associated with cognitive impairment
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DOI：
10.1016/j.jns.2013.02.019
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发表时间：
2013-05-15
影响因子：
4.4
通讯作者：
Vernieri, Fabrizio
中科院分区：
文献类型：
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作者：
Maggio, Paola;Altamura, Claudia;Vernieri, Fabrizio
颈动脉支架植入术（CAS）对认知功能的影响仍存在争议。脑微栓塞，通过术后弥散加权成像（DWI）病变可检测到，已被认为易导致认知能力下降。我们的研究旨在评估CAS对认知状况的影响，重点关注脑微栓塞病变的潜在作用，同时考虑可能影响认知状态的因素（人口统计学特征、血管风险概况、基线神经心理学评估和脑结构损伤的磁共振（MR）标记物）的影响。37例颈动脉严重狭窄患者入组。术后1天进行神经学评估（E0）、神经心理学评估及脑MR检查。术后第1天复查DWI脑MR (E1)，中位期14个月后进行神经心理学评估（E2）。轴向MR FLAIR和T1w-SE序列分别在E0处估计白质高信号和全脑体积。未经调整的方差分析显示，CAS*DWI对MMSE有显著的交互作用（F = 7.154(32), p = 0.012）。在调整了可能影响认知状态的因素后，CAS（*）证实了MMSE的DWI相互作用（F = 7.092(13), p = 0.020）。有DWI病变组E2-E0 MMSE平均降低-3.1，无DWI病变组E2-E0 MMSE平均降低+1.1。我们的研究表明，围手术期脑微栓塞负荷对认知功能有负面影响，独立于患者相关变量的影响。(c) 2013 Elsevier B.V.版权所有
The effect of carotid artery stenting (CAS) on cognitive function is still debated. Cerebral microembolism, detectable by post-procedural diffusion-weighted imaging (DWI) lesions, has been suggested to predispose to cognitive decline. Our study aimed at evaluating the effect of CAS on cognitive profile focusing on the potential role of cerebral microembolic lesions, taking into consideration the impact of factors potentially influencing cognitive status (demographic features, vascular risk profile, neuropsychological evaluation at baseline and magnetic resonance (MR) markers of brain structural damage). Thirty-seven patients with severe carotid artery stenosis were enrolled. Neurological assessment neuropsychological evaluation and brain MR were performed the day before CAS (E0). Brain MR with DWI was repeated the day after CAS (E1), while neuropsychological evaluation was done after a 14-month median period (E2). Volumes of both white matter hyperintensities and whole brain were estimated at E0 on axial MR FLAIR and T1w-SE sequences, respectively. Unadjusted ANOVA analysis showed a significant CAS*DWI interaction for MMSE (F = 7.154(32), p = .012). After adjusting for factors potentially influencing cognitive status CAS(*)DWI interaction was confirmed for MMSE (F = 7.092(13), p = .020). Patients with DWI lesions showed a mean E2-E0 MMSE reduction of -3.1, while group without DWI lesions showed a mean E2-E0 MMSE of +1.1. Our study showed that peri-procedural brain microembolic load impacts negatively on cognitive functions, independently from the influence of patients-related variables. (c) 2013 Elsevier B.V. All rights reserved.