Association of the Recovery of Objective Abnormal Cerebral Perfusion With Neurocognitive Improvement After Carotid Revascularization

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:61

Article

Huang, Ching-Chang¹  Chen, Ying-Hsien¹  Lin, Mao-Shin^1,2  Lin, Cheng-Hsin^2,3  Li, Hung-Yuan¹  Chiu, Ming-Jang^4,5  Chao, Chi-Chao⁴  Wu, Yen-Wen^1,6,7,8,9  Chen, Ya-Fang¹⁰  Lee, Jen-Kuang¹¹  Wang, Ming-Jiuh¹²  Chen, Ming-Fong¹  Kao, Hsien-Li¹ 

[1] Natl Taiwan Univ Hosp, Dept Internal Med, Taipei 100, Taiwan

[2] Natl Taiwan Univ, Coll Med, Grad Inst Clin Med, Taipei 10764, Taiwan

[3] Natl Taiwan Univ Hosp, Dept Surg, Taipei 100, Taiwan

[4] Natl Taiwan Univ Hosp, Dept Neurol, Taipei 100, Taiwan

[5] Natl Taiwan Univ, Dept Psychol, Taipei 10764, Taiwan

[6] Natl Taiwan Univ Hosp, Dept Nucl Med, Taipei 100, Taiwan

[7] Far Eastern Mem Hosp, Dept Nucl Med, New Taipei City, Taiwan

[8] Far Eastern Mem Hosp, Cardiovasc Med Ctr, Div Cardiol, New Taipei City, Taiwan

[9] Natl Yang Ming Univ, Sch Med, Taipei 112, Taiwan

[10] Natl Taiwan Univ Hosp, Dept Med Imaging, Taipei 100, Taiwan

[11] Far Eastern Mem Hosp, Dept Lab Med, New Taipei City, Taiwan

[12] Natl Taiwan Univ Hosp, Dept Anesthesiol, Taipei 100, Taiwan

关键词: brain perfusion;    carotid stenosis;    carotid stenting;    neurocognitive function;   

DOI  :  10.1016/j.jacc.2013.02.059

来源: Elsevier

【 摘 要 】

Objectives This study sought to report the effect of carotid artery stenting (CS) on neurocognitive function (NCF) in patients with severe carotid artery occlusive disease, depending on baseline brain perfusion status. Background The effect of CS on NCF has been controversial. Methods We prospectively enrolled 61 patients with carotid artery disease (22 with occlusion, 39 with severe stenosis) in whom CS was attempted. Computed tomography perfusion and NCF assessments including Mini-Mental State Examination (MMSE), Alzheimer Disease Assessment Scale-Cognitive subscale (ADAS-Cog), verbal fluency, and Color Trails Test Parts 1 and 2 were applied before and 3 months after intervention. Results Successful recanalization was achieved in 14 of 22 occlusion patients (64%) and in all 39 severe stenosis patients. Two cases were excluded due to procedural cerebral complications. The patients were divided into 3 groups: group 1 (n = 8) consisted of patients with abnormal baseline ipsilateral cerebral perfusion in whom CS failed; group 2 (n = 33) consisted of patients with abnormal baseline ipsilateral cerebral perfusion in whom CS was successful; and group 3 (n = 19) consisted of patients without abnormal baseline ipsilateral cerebral perfusion in whom CS was successful. The demographics and baseline NCF were similar among groups. Only in group 2 was there significant improvement in ADAS-Cog (pre-procedure median [interquartile range]: 6 [4 to 9] vs. post-procedure: 5 [3 to 7], p = 0.002), MMSE (pre-procedure: 27 [25 to 28] vs. post-procedure: 28 [25 to 29], p = 0.004) and Color Trails Test Part 1 (pre-procedure: 100 [78.5 to 136.5] s vs. post-procedure: 97 [60 to 128.5] s, p = 0.003) after CS. Significant difference in changes from baseline was observed only in the Color Trails Test Part 1 among groups (group 1 vs. 2 vs. 3: 1.5 [-14 to 11.5] vs. -12.5 [-36.5 to 0.5] vs. -0.5 [-11 to 27], p = 0.0159). Significant correlation between the change of ipsilateral brain perfusion and MMSE (r = -0.33, p = 0.01) was also identified. Conclusions Successful CS for severe carotid stenosis/occlusion improves NCF, but only in patients with objective baseline abnormal cerebral perfusion. (C) 2013 by the American College of Cardiology Foundation

【 授权许可】

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