颈动脉支架置入术对无症状性颈动脉高度狭窄患者认知功能的影响

Effects of carotid artery stenting on cognitive function in patients with critical internal carotid artery stenosis

目的探讨颈动脉支架置入术对无症状性颈动脉高度狭窄患者认知功能的影响。方法选择2009年9月至2012年12月期间在该科住院患者156例(狭窄程度大于或等于70%),行颈动脉支架置入术。在支架置入术前1周内及置入术后3个月采用阿尔茨海默病评估量表认知部分(ADAS-Cog)、简易智能量表(MMSE)、连线测验(TMTa、TMTb)对患者的认知功能进行评估。结果所有患者均安全、成功的置入颈动脉支架,其中1例患者术后失访。与术前相比,术后3个月患者的认知功能均有所改善,术前术后比较:ADAS-Cog[(6.60±2.04)分vs.(5.16±1.63)分,P<0.01],MMSE[(26.32±1.06)分vs.(27.05±1.46)分,P<0.01],TMTa[(108.94±17.42)分vs.(94.70±20.27)分,P<0.01],TMTb[(178.65±21.77)分vs.(148.92±23.65)分,P<0.01],术后3个月内无新发脑梗死。结论颈动脉狭窄可能为认知功能减退的原因之一,颈动脉支架置入术可以改善无症状颈动脉狭窄患者认知功能。

Objective To investigate the influence of carotid artery stenting （CS）of asymptomatic critical internal carotid artery （ICA）stenosis patients on cognitive function .Methods One hundred and fifty-six asymptomatic patients with internal carotid artery stenosis（carotid stenosis severity≥70% ）were enrolled ,in whom CS was attempted .Functional assessments including alzheimer disease assessment scale-cognitive subtest （ADAS-Cog） ,mini-mental state examination （MMSE） ,and trail making test A（TMTa） and B（TMTb） were done prior to 1 weeks and 3 months after the procedure .Results Successful CS was achieved in all of patients （100% ） ,only 1 patient was lost to follow-up .There were significant improvement in ADAS-Cog score（pre 6 .60 ± 2 .04 vs .post 5 .16 ± 1 .63 ,P〈0 .01） ,MMSE score （pre 26 .32 ± 1 .06 vs .post 27 .05 ± 1 .46 ,P〈 0 .01） ,TMTa （pre 108 .94 ± 17 .42 vs .post 94 .70 ± 20 .27 ,P〈0 .01） ,TMTb （pre 178 .65 ± 21 .77 vs .post 148 .92 ± 23 .65 ,P〈0 .01） .There was new cerebral infarction during 3 months after surgery .Conclusion Asymptomatic critical internal carotid artery （ICA）stenosis may be one reason of cognitive impairment ,and successful CS could improve cognitive function in asymptomatic ICA stenosis .