颈动脉血管重建术对颈动脉狭窄患者认知功能的影响

doi:10.3969/j.issn.1673-5765.2020.10.019

摘要/Abstract

摘要：

颈动脉狭窄会导致患者远期认知功能下降，而既往研究表明颈动脉内膜剥脱术和支架置入术作为治疗颈动脉狭窄的主要术式，可以改善患者的认知功能，尤其是执行能力等特定领域的认知水平。进一步研究发现颈动脉血管重建术中栓子的形成，术后脑血流灌注提高，以及神经代谢水平等改变可能在机制上解释颈动脉重建术后认知功能的变化；此外，围术期炎症反应，血脂水平，以及基因易感性等都是术后远期认知功能结局的临床预测因素，以上因素对于提高颈动脉狭窄患者的生活质量、治疗术式的优化具有重要临床意义。

文章导读： 颈动脉内膜剥脱术和支架置入术作为治疗颈动脉狭窄的主要术式，可以改善患者的认知功能，尤其是执行能力等特定领域的认知水平。

关键词: 颈动脉狭窄; 颈动脉支架置入术; 颈动脉内膜剥脱术; 认知功能

Abstract:

Carotid stenosis can lead to long-term cognitive function decline. Carotid endarterectomy and carotid artery stenting, two major procedures for carotid stenosis, have been proven to improve the cognitive function, especially for executive domain. Further studies found that the formation of emboli during the operation, the increase of cerebral blood flow perfusion and the change of neurometabolism might account for the changes in cognitive function after carotid revascularization. In addition, perioperative inflammatory response, lipid level and gene susceptibility may be predictors of long-term cognitive prognosis, and all the above factors are of great clinical significance for improving the life quality of patients with carotid stenosis and optimizing the procedures.

Key words: Carotid stenosis; Carotid artery stenting; Carotid endarterectomy; Cognitive function

滕乐群，沈晨阳. 颈动脉血管重建术对颈动脉狭窄患者认知功能的影响[J]. 中国卒中杂志, 2020, 15(10): 1128-1133.

TENG Le-Qun,SHEN Chen-Yang. Effects of Carotid Revascularization on Cognitive Function in Patients with Carotid Stenosis[J]. Chinese Journal of Stroke, 2020, 15(10): 1128-1133.

参考文献

[1] SABIA S，FAYOSSE A，DUMURGIER J，et al.

Association of ideal cardiovascular health at age 50

with incidence of dementia：25 year follow-up of

Whitehall Ⅱ cohort study[J/OL]. BMJ，2019，366：

l4414[2019-08-20]. https：//doi.org/10.1136/bmj.l4414.

[2] JOHNSTON S C，O'MEARA E S，MANOLIO T A，et

al. Cognitive impairment and decline are associated

with carotid artery disease in patients without clinically

evident cerebrovascular disease[J]. Ann Intern Med，

2004，140（4）：237-247.

[3] LATTANZI S，CARBONARI L，PAGLIARICCIO G，

et al. Neurocognitive functioning and cerebrovascular

reactivity after carotid endarterectomy[J/OL].

Neurology，2018，90（4）：e307-e315[2019-08-20].

https：//doi.org/10.1212/WNL.0000000000004862.

[4] ZHANG X Q，MA H，LI L，et al. Neurocognitive

changes after carotid revascularization according

to perfusion parameters：a meta-analysis of

current literature[J/OL]. Ann Vasc Surg，2020，

64：361-374[2019-08-20]. https：//doi.org/10.1016/

j.avsg.2019.01.008.

[5] TANI N，YAEGAKI T，NISHINO A，et al. Functional

connectivity analysis and prediction of cognitive

change after carotid artery stenting[J]. J Neurosurg，

2018，131（6）：1709-1715.

[6] PUCITE E，KRIEVINA I，MIGLANE E，et al.

Changes in cognition，depression and quality of life

after carotid stenosis treatment[J]. Curr Neurovasc Res，

2019，16（1）：47-62.

[7] HARA S，SEIDA M，KUMAGAI K，et al. Beneficial

effect of carotid artery stenting on cerebral

hemodynamic impairment and cognitive function[J].

Neurol Med Chir（Tokyo），2020，60（2）：66-74.

[8] CASAS-HERNANZ L，GAROLERA M，BADENES

D，et al. Neuropsychological outcome one year after

carotid revascularization：a before-and-after study[J].

Vasc Specialist Int，2017，33（4）：146-155.

[9] ALTINBAS A，VAN ZANDVOORT M J，VAN DEN

BERG E，et al. Cognition after carotid endarterectomy

or stenting：a randomized comparison[J]. Neurology，

2011，77（11）：1084-1090.

[10] WITT K，BÖRSCH K，DANIELS C，et al.

Neuropsychological consequences of endarterectomy

and endovascular angioplasty with stent placement

for treatment of symptomatic carotid stenosis：a

prospective randomised study[J]. J Neurol，2007，254

（11）：1524-1532.

[11] PLESSERS M，VAN HERZEELE I，HEMELSOET

D，et al. Prospective comparison of cognitive effects

of carotid endarterectomy versus carotid stenting

with flow reversal or distal filters[J]. J Clin Exp

Neuropsychol，2016，37（8）：834-841.

[12] LAL B K，YOUNES M，CRUZ G，et al. Cognitive

changes after surgery vs stenting for carotid artery

stenosis[J]. J Vasc Surg，2011，54（3）：691-698.

[13] CRAWLEY F，STYGALL J，LUNN S，et al.

Comparison of microembolism detected by transcranial

Doppler and neuropsychological sequelae of carotid

surgery and percutaneous transluminal angioplasty[J].

Stroke，2000，31（6）：1329-1334.

[14] WASSER K，HILDEBRANDT H，GRÖSCHEL S，et

al. Age-dependent effects of carotid endarterectomy or

stenting on cognitive performance[J]. J Neurol，2012，

259（11）：2309-2318.

[15] HACHINSKI V，IADECOLA C，PETERSEN R C，et

al. National Institute of Neurological Disorders and

Stroke-Canadian Stroke Network vascular cognitive

impairment harmonization standards[J]. Stroke，2006，

37（9）：2220-2241.

[16] NYENHUIS D L，GORELICK P B，GEENEN E

J，et al. The pattern of neuropsychological deficits in

Vascular Cognitive Impairment-No Dementia（Vascular

CIND）[J]. Clin Neuropsychol，2004，18（1）：41-49.

[17] SCHERR M，KUNZ A，DOLL A，et al. Ignoring floor

and ceiling effects may underestimate the effect of

carotid artery stenting on cognitive performance[J]. J

Neurointerv Surg，2016，8（7）：747-751.

[18] TAKAHASHI Y，OGASAWARA K，MATSUMOTO

Y，et al. Changes in cognitive function after carotid

endarterectomy in older patients：comparison with

younger patients[J]. Neurol Med Chir（Tokyo），2013，

53（6）：353-359.

[19] INOUE T，OHWAKI K，TAMURA A，et al.

Subclinical ischemia verified by somatosensory

evoked potential amplitude reduction during carotid

endarterectomy：negative effects on cognitive

performance[J]. J Neurosurg，2013，118（5）：1023-

1029.

[20] BARACCHINI C，MAZZALAI F，GRUPPO M，et

al. Carotid endarterectomy protects elderly patients

from cognitive decline：a prospective study[J]. Surgery，

2017，151（1）：99-106.

[21] ORTEGA G，ÁLVAREZ B，QUINTANA M，et

al. Cognitive improvement in patients with severe

carotid artery stenosis after transcervical stenting with

protective flow reversal[J]. Cerebrovasc Dis，2013，35

（2）：124-130.

[22] SATO Y，ITO K，OGASAWARA K，et al.

Postoperative increase in cerebral white matter

fractional anisotropy on diffusion tensor magnetic

resonance imaging is associated with cognitive improvement after uncomplicated carotid

endarterectomy：tract-based spatial statistics

analysis[J]. Neurosurgery，2013，73（4）：592-598；

discussion 598-599.

[23] WILSON D A，MOCCO J，D'AMBROSIO A L，et al.

Post-carotid endarterectomy neurocognitive decline

is associated with cerebral blood flow asymmetry on

post-operative magnetic resonance perfusion brain

scans[J]. Neurol Res，2008，30（3）：302-306.

[24] WANG Q，ZHOU M，ZHOU Y，et al. Effects of

carotid endarterectomy on cerebral reperfusion and

cognitive function in patients with high grade carotid

stenosis：a perfusion weighted magnetic resonance

imaging study[J]. Eur J Vasc Endovasc Surg，2015，50

（1）：5-12.

[25] CONNOLLY E S Jr，WINFREE C J，RAMPERSAD

A，et al. Serum S100B protein levels are correlated

with subclinical neurocognitive declines after carotid

endarterectomy[J]. Neurosurgery，2001，49（5）：

1076-1082；discussion 1082-1083.

[26] ZHOU W，HITCHNER E，GILLIS K，et al.

Prospective neurocognitive evaluation of patients

undergoing carotid interventions[J]. J Vasc Surg，2012，

56（6）：1571-1578.

[27] ZHOU W，BAUGHMAN B D，SOMAN S，et al.

Volume of subclinical embolic infarct correlates

to long-term cognitive changes after carotid

revascularization[J]. J Vasc Surg，2017，65（3）：686-

694.

[28] ROTS M L，MEERSHOEK A J A，BONATI L H，et

al. Editor's choice - predictors of new ischaemic brain

lesions on diffusion weighted imaging after carotid

stenting and endarterectomy：a systematic review[J].

Eur J Vasc Endovasc Surg，2019，58（2）：163-174.

[29] HITCHNER E，BAUGHMAN B D，SOMAN S，et

al. Microembolization is associated with transient

cognitive decline in patients undergoing carotid

interventions[J]. J Vasc Surg，2016，64（6）：1719-

1725.

[30] YOSHIDA K，OGASAWARA K，SAURA H，et

al. Post-carotid endarterectomy changes in cerebral

glucose metabolism on 18F-fluorodeoxyglucose

positron emission tomography associated with

postoperative improvement or impairment in cognitive

function[J]. J Neurosurg，2015，123（6）：1546-1554.

[31] SAITO H，OGASAWARA K，NISHIMOTO H，et

al. Postoperative changes in cerebral metabolites

associated with cognitive improvement and

impairment after carotid endarterectomy：a 3T proton

MR spectroscopy study[J]. AJNR Am J Neuroradiol，

2013，34（5）：976-982.

[32] CHIDA K，OGASAWARA K，SUGA Y，et al.

Postoperative cortical neural loss associated with

cerebral hyperperfusion and cognitive impairment

after carotid endarterectomy：123I-iomazenil SPECT

study[J]. Stroke，2009，40（2）：448-453.

[33] ZUNIGA M C，TRAN T B，BAUGHMAN B D，et

al. A prospective evaluation of systemic biomarkers

and cognitive function associated with carotid

revascularization[J]. Ann Surg，2016，264（4）：659-

665.

[34] HEYER E J，MERGECHE J L，WARD J T，et

al. Phosphodiesterase 4D single-nucleotide

polymorphism 83 and cognitive dysfunction in carotid

endarterectomy patients[J]. Neurosurgery，2013，73

（5）：791-796；discussion 796.

[35] HEYER E J，MERGECHE J L，STERN Y，et al.

Apolipoprotein E-ε4 polymorphism and cognitive

dysfunction after carotid endarterectomy[J]. J Clin

Neurosci，2014，21（2）：236-240.

[36] HALAZUN H J，MERGECHE J L，MALLON K

A，et al. Neutrophil-lymphocyte ratio as a predictor

of cognitive dysfunction in carotid endarterectomy

patients[J]. J Vasc Surg，2014，59（3）：768-773.

[37] ROBISON T R，HEYER E J，WANG S，et al.

Easily screenable characteristics associated with

cognitive improvement and dysfunction after carotid

endarterectomy[J/OL]. World Neurosurg，2019，121：

e200-e206[2019-08-20]. https：//doi.org/10.1016/

j.wneu.2018.09.076.

[38] MERGECHE J L，BRUCE S S，SANDER

CONNOLLY E，et al. Reduced middle cerebral

artery velocity during cross-clamp predicts cognitive

dysfunction after carotid endarterectomy[J]. J Clin

Neurosci，2014，21（3）：406-411.

[39] HEYER E J，MERGECHE J L，ANASTASIAN

Z H，et al. Arterial blood pressure management

during carotid endarterectomy and early cognitive

dysfunction[J]. Neurosurgery，2014，74（3）：245-251；

discussion 251-253.

[40] GE Y L，LI Q，NIE Y Y，et al. Dexmedetomidine

improves cognition after carotid endarterectomy by

inhibiting cerebral inflammation and enhancing brainderived

neurotrophic factor expression[J]. J Int Med

Res，2019，47（6）：2471-2482.