Development of cerebral microbleeds in patients with cerebral hyperperfusion following carotid endarterectomy and its relation to postoperative cognitive decline
Development of cerebral microbleeds in patients with cerebral hyperperfusion following carotid endarterectomy and its relation to postoperative cognitive decline
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DOI：
10.3171/2020.7.jns202353
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发表时间：
2021-10-01
影响因子：
4.1
通讯作者：
Ogasawara, Kuniaki
中科院分区：
文献类型：
--
作者：
Igarashi, Suguru;Ando, Toshihiko;Ogasawara, Kuniaki
目的
颈动脉内膜切除术（CEA）后认知能力下降的一个主要原因是脑过度灌注导致的脑损伤。然而，脑过度灌注如何导致大脑皮质和白质损伤的机制尚不清楚。磁敏感加权成像（SWI）上脑微出血（CMBs）的存在与整体认知功能下降独立相关。这项前瞻性观察研究的目的是确定CEA后的脑过度灌注是否会导致CMBs的产生，以及术后认知能力下降是否与这些产生的CMBs有关。
方法
在27个月的研究期间，因同侧颈内动脉狭窄（≥70%）接受CEA的患者在手术前和术后2个月还接受了SWI和神经心理学测试，以及在手术前和手术后立即进行定量脑灌注单光子发射计算机断层成像（SPECT）。
结果
根据手术前后的定量脑灌注SPECT和SWI，75例患者中有12例（16%）和7例（9%）分别在手术同侧大脑半球出现术后脑过度灌注和CMBs增加。脑过度灌注与术后CMBs增加相关（逻辑回归分析，95%置信区间5.08 - 31.25，p < 0.0001）。根据手术前后的神经心理学评估，10例患者（13%）出现术后认知能力下降。CMBs增加与术后认知能力下降相关（逻辑回归分析，95%置信区间6.80 - 66.67，p < 0.0001）。在术后出现脑过度灌注的患者中，CMBs增加的患者术后认知能力下降的发生率（100%）高于无CMBs增加的患者（20%；p = 0.0101）。
结论
CEA后的脑过度灌注会导致CMBs的产生，术后认知能力下降与这些产生的CMBs有关。
OBJECTIVE A primary cause of cognitive decline after carotid endarterectomy (CEA) is cerebral injury due to cerebral hyperperfusion. However, the mechanisms of how cerebral hyperperfusion induces cerebral cortex and white matter injury are not known. The presence of cerebral microbleeds (CMBs) on susceptibility-weighted imaging (SWI) is independently associated with a decline in global cognitive function. The purpose of this prospective observational study was to determine whether cerebral hyperperfusion following CEA leads to the development of CMBs and if postoperative cogni-tive decline is related to these developed CMBs.METHODS During the 27-month study period, patients who underwent CEA for ipsilateral internal carotid artery stenosis (>= 70%) also underwent SWI and neuropsychological testing before and 2 months after surgery, as well as quantitative brain perfusion SPECT prior to and immediately after surgery.RESULTS According to quantitative brain perfusion SPECT and SWI before and after surgery, 12 (16%) and 7 (9%) of 75 patients exhibited postoperative cerebral hyperperfusion and increased CMBs in the cerebral hemisphere ipsilateral to surgery, respectively. Cerebral hyperperfusion was associated with an increase in CMBs after surgery (logistic regres-sion analysis, 95% CI 5.08-31.25, p < 0.0001). According to neuropsychological assessments before and after surgery, 10 patients (13%) showed postoperative cognitive decline. Increased CMBs were associated with cognitive decline after surgery (logistic regression analysis, 95% CI 6.80-66.67, p < 0.0001). Among the patients with cerebral hyperperfusion after surgery, the incidence of postoperative cognitive decline was higher in those with increased CMBs (100%) than in those without (20%; p = 0.0101).CONCLUSIONS Cerebral hyperperfusion following CEA leads to the development of CMBs, and postoperative cogni-tive decline is related to these developed CMBs.