颈内动脉支架置入术对颈动脉狭窄患者认知功能影响的研究

目的：研究颈动脉狭窄对认知功能的影响，探讨颈动脉支架置入术（CAS）患者术后不同时期认知功能的变化及其可能的机制。方法：选取2010年1月至2012年12月我院神经内科收住的急性脑梗死（前循环）患者75例，按颈内动脉狭窄程度，分成无狭窄组，轻度狭窄组（狭窄程度〈30％），中度狭窄组（30-69％）和治疗组（70．99％），前三组给予药物治疗，治疗组同时给予颈内动脉支架置入术，应用蒙特利尔认知评估量表（MoCA）、简易精神状态检查表（MMSE）、搭火柴测验（stickTest），对患者进行认知功能评估，比较术前、术后不同时期认知功能的变化，同时利用SPECT／CT对治疗组20例患者术后局部脑血流改善状况进行评价。结果：治疗组和对照组在术前比较MoCA总分、MMSE评分、StickTest评分，发现治疗组评分低于对照组，且随着颈动脉狭窄程度的加重，认知功能受损越明显；治疗组在术后1周与术前比较，评分反而降低，差异有统计学意义；术后3个月、术后6个月与术前比较，评分均有所提高，差异有统计学意义；通过SPECT／CT对治疗组术前感兴趣区血流量与同侧小脑平均脑血流量比较，术后再与同侧小脑比较，结果显示术后脑灌注明显改善。结论：颈动脉狭窄与血管性认知功能障碍有关，而且认知功能障碍的程度与颈动脉狭窄程度呈正相关，颈内动脉支架置入术可最终改善认知功能，尤其表现在视空间／执行能力，延迟回忆能力，注意力等方面。

Effect of Carotid Artery Stenting on the Cognitive Impairment for Patients with Carotid Artery Stenosis

Objective： To investigate the influence of carotid artery stenosis on cognitive function, so as to study the post-CAS （carotid artery stenting） cognitive changes for the patients in various post-operation period, as well as the possible mechanisms. Methods： The patients with acute cerebral infarction （anterior circulation） who were admitted in the Department of Neurology in our hospital from January 2010 to December 2012 were enrolled and divided into four groups on the basis of the severity of carotid stenosis, namely, the group without obvious stenosis, mild stenosis （〈30%）, moderate stenosis （between 30% and 69%） and the treatment group （between 70% and 99%）. The patients in the first three groups were only received the medication, while the patients in the treatment group were also underwent CAS besides medication. The cognitive functions of the patients were assessed by Montreal Cognitive Assessment （MoCA）, Mini-Mental State Examination （MMSE） and Stick Test. The changes in cognitive functions were compared between the pre-operation and the various post-operation. In addition, SPECT/CT was employed to evaluate the post-operative improvement in local cerebral blood flow. Results： In pre-operation assessments, the patients in the treatment group had lower MoCA total scores, lower MMSE scores and lower Stick Test scores when compared with those in the control groups. Furthermore, their cognitive functions turned to be more impaired as the severity of carotid stenosis increased. The differences in the scores between the patients in the serious stenosis group （treatment group） and those in the mild or moderate stenosis groups were statistically significant. In the first week after CAS procedure, the performances of the patients in the treatment group at the various cognitive tests （MoCA, visual-spatial ability/executive function, delayed recall ability, concentration, MMSE, Stick test and ects.） all declined, with statistically significant differences when compared with pre-operation scores. However, in the evaluations on 3- and 6-months post operation, these patients showed much improved performances in all of these tests; and the improvements were statistically significant. From the images obtained from the patients in the treatment group by employing SPECT/CT superposition, the cerebral blood flows in the targeted brain areas were compared with the average blood flow in the ipsilateral cerebellum both pre- and post-operatively; and the results showed that cerebral perfusion after CAS was much improved, with statistically significant difference. Conclusions： Carotid artery stenosis was associated with vascular cognitive impairment, and the severity of impairment was positively correlated with the severity of stenosis, i.e. the severity of stenosis increased as the severity of cognitive dysfunction increased. CAS was proved to be able to improve cognitive function, especially for the visual-spatial ability/executive function, delayed recall ability, concentration and so on.