血管内治疗对椎基底动脉中重度狭窄患者认知功能的影响

Effect of endovascular therapy on cognitive function in patients with moderate or severe vertebrobasilar artery stenosis

目的 探讨血管内治疗对椎基底动脉中重度狭窄患者认知功能障碍治疗的价值。方法 前瞻性纳入2019年3月-2022年11月在日照市人民医院神经内科门诊及住院治疗的基底动脉狭窄的认知功能障碍的患者78例,根据是否行血管内治疗分为血管内支架植入(Endovascular Stenting, EVS)组及非EVS组,在治疗前后对其进行注意与处理速度—连线试验(TMT-A)、执行功能—连线试验(TMT-B)、简易智力状态检查量表(Mini-mental State Examination, MMSE)问卷调查。并追踪随访6个月,再次进行TMT-A、TMT-B、MMSE等神经心理学测验。治疗前后分别进行2次CT灌注(CT perfusion, CTP)检查,评估患者的脑血流灌注情况。对两组的临床资料进行比较,总结对认知功能障碍治疗的效果。结果 研究期间纳入78例患者,年龄(45.03±13.00)岁,男女比例为1.79∶1,EVS组及非EVS组在年龄、性别、受教育年限、高血压、糖尿病、卒中史、吸烟史、饮酒史等方面均未见统计学差异(P均>0.05)。治疗后1周内,MMSE改善情况EVS组与非EVS组有统计学差异(P<0.001)。TMT-A、TMT-B变化两组未见统计学差异(P均>0.05)。随访6个月后,EVS组在MMSE、TMT-A、TMT-B改善情况优于非EVS组(P均<0.05)。EVS组在术后脑血流灌注得到明显改善,TTP明显缩短,CVB增加。非EVS组未见相似变化。结论 椎基底动脉狭窄血管内支架植入治疗对认知功能的改善具有一定的临床价值,且随时间延长效果愈明显。

Objective To investigate the value of endovascular therapy for cognitive dysfunction in patients with moderate or severe vertebrobasilar artery stenosis.Methods A total of 78 patients with cognitive dysfunction due to basilar artery stenosis who were treated in the Outpatient and Inpatient Department of Neurology,People′s Hospital of Rizhao,China from March 2019 to November 2022 were prospectively enrolled and divided into endovascular stenting(EVS)group and non-EVS group according to whether they underwent endovascular therapy.Before and after treatment,attention and processing speed-trail making test(TMT)-A,executive function-TMT-B,and mini-mental state examination(MMSE)were conducted.These neuropsychological tests were carried out again after 6 months of follow-up.Computed tomography perfusion examination was performed twice before and after treatment to evaluate the patients'cerebral blood perfusion.The clinical data of the two groups were compared to summarize the therapeutic effect on cognitive dysfunction.Results A total of 78 patients,aged(45.03±13.00)years,with a male-to-female ratio of 1.79∶1,were included in the study.There were no significant differences between the EVS group and the non-EVS group in age,sex,years of education,hypertension,diabetes,stroke history,smoking history,and drinking history(P>0.05).Within one week after treatment,MMSE improvement was significantly different between the EVS group and the non-EVS group(P<0.001).There were no significant differences in the changes in TMT-A and TMT-B between the two groups(P>0.05).After 6 months of follow-up,the improvements in MMSE,TMT-A,and TMT-B in the EVS group were better than those in the non-EVS group(P<0.05).In the EVS group,cerebral blood perfusion was significantly improved,the time to peak was significantly shortened,and the cerebral blood flow was increased.No similar changes were observed in the non-EVS group.Conclusion Endovascular stenting for vertebrobasilar artery stenosis has a certain clinical value in improving cognitive function,and the effect becomes more obvious with the extension of time.