血管内再通术对慢性颈内动脉闭塞患者认知功能的影响

Effect of Endovascular Recanalization on Cognitive Function in Patients with Chronic Internal Carotid Artery Occlusion

目的应用脑CT灌注成像、简易精神状态量表(MMSE)及蒙特利尔认知量表(MoCS)来探讨慢性颈内动脉闭塞患者行血管内再通术后认知功能的变化情况。方法回顾性分析2020年8月至2022年9月内蒙古自治区人民医院神经外科收治的20例行血管内再通术治疗的慢性颈内动脉闭塞患者的临床资料。分别于术前1周内和术后3个月行CTP检查评估脑血流动力学情况,并使用MMSE及MoCA量表分别对患者手术前后的认知功能进行评分,最后分别比较患者手术前后脑灌注及认知功能的情况。结果20例患者于术前1周内、术后3个月分别行脑CTP检查,结果显示,局部血流量、局部脑血容量、平均通过时间和达峰时间与术前比较均有显著改善,差异具有统计学意义(P<0.05);手术前病变侧和对侧的rCBF相比较差异有统计学意义(P<0.05);手术后病变侧的灌注情况明显改善,与对侧rCBF相比较差异有统计学意义(P<0.05)。20例患者手术前后MMSE评分总分和MoCA评分总分差异具有统计学意义(P<0.05)。MMSE评分中定向力、注意力、计算力和语言功能改善显著,差异具有统计学意义。MoCA评分中视空间/执行力、命名、抽象能力、定向力较术前改善明显,差异具有统计学意义(P<0.05)。结论血管内再通术可以提高颈内动脉闭塞患者的脑灌注情况,同时对患者的认知功能也有不同程度的改善。

Objective To investigate the changes of cognitive function after endovascular revascularization in patients with chronic internal carotid artery occlusion by applying CT perfusion imaging,the mini-mental state examination and the Montreal cognitive assessment.Methods The clinical data of 20 patients with CICAO who were admitted to our neurosurgery department for endovascular revascularization from August 2020 to September 2022 were retrospectively analyzed.The cerebral hemodynamics were assessed by CTP examination 1 week before and 3 months after surgery,and the cognitive function of patients before and after surgery was scored using the MMSE and MoCA scales,and finally the cerebral perfusion and cognitive function of patients before and after surgery were compared.Results The results showed that the regional cerebral blood flow,regional cerebral blood volume,mean transition time,and time to peak were significantly improved in 20 patients 3 months after surgery,and the differences were statistically significant(P<0.05).The differences were statistically significant(P<0.05);the differences in rCBF,rCBV between the lesion side and the contralateral side before surgery were statistically significant(P<0.05).The difference between the total MMSE score and the total MoCA score before and after surgery was statistically significant in 20 patients(P<0.05).Spatial/executive ability,naming,abstraction,and orientation improved significantly compared with the preoperative scores,and the differences were classmate significant(P<0.05).Conclusion Endovascular recanalization can improve cerebral perfusion in patients with internal carotid artery occlusion,and also has different degrees of improvement on cognitive function of patients.