血管内治疗对认知功能影响的多重性

The diversity of effects of cerebral endovascular treatment on cognitive function

颅内大动脉粥样硬化性狭窄不仅与缺血性卒中相关,同时还与认知功能障碍密切相关。脑低灌注是此类患者认知损害的重要病理生理学机制,这种因血流动力学改变所引起的认知损害呈可逆性,虽然颈动脉内膜切除术和支架成形术对改善脑组织灌注有效,但术中微栓塞和术后高灌注可损伤认知功能,如此造成患者术后认知功能的改善结果不尽一致。关注颅内动脉狭窄患者的认知功能预后,不断改进血管内治疗方式和围手术期管理模式,方可使患者真正受益。

Cerebrovascular stenosis is not only associated with ischemic stroke, but also with cognitive dysfunction. Hypoperfusion is an important mechanism of cognitive dysfunction. In such patients, the hemodynamics of cognitive impairment is reversible. Although carotid endarterectomy or angioplasty can significantly improve the perfusion, but the microemboli and perfusion abnormalities induced in operation may be harmful to cognitive function. So the cognitive improvement is diversity after the treatment. Attention should be paid to the cognitive function of patients with cerebrovascular stenosis, and continuous optimization of interventional operation methods and perioperative management could improve the cognitive function in endovascular therapy.