Diffusion-weighted lesions after carotid artery stenting are associated with cognitive impairment

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• 作者：Paola Maggio^a ; Claudia Altamura^a ; Doriana Landi^a ; Simone Migliore^a ; Domenico Lupoi^b ; Filomena Moffa^c ; Livia Quintiliani^a ; Stefano Vollaro^a ; Paola Palazzo^a ; Riccardo Altavilla^a ; Patrizio Pasqualetti^d ; ^e ; Yuri Errante^f ; Carlo Cosimo Quattrocchi^f ; Francesco Tibuzzi^c ; Francesco Passarelli^c ; Roberto Arpesani^b ; Guido di Giambattista^b ; Francesco Rosario Grasso^f ; Giacomo Luppi^f ; Fabrizio Vernieri^a ; ^{f.vernieri@unicampus.it}
• 关键词：Carotid artery stenting ; Cognitive performance ; DWI lesion
• 刊名：Journal of the Neurological Sciences
• 出版年：2013
• 出版时间：15 May, 2013
• 年：2013
• 卷：328
• 期：1-2
• 页码：58-63
• 全文大小：454 K

文摘

The effect of carotid artery stenting (CAS) on cognitive function is still debated. Cerebral microembolism, detectable by post-procedural diffusion-weighted imaging (DWI) lesions, has been suggested to predispose to cognitive decline. Our study aimed at evaluating the effect of CAS on cognitive profile focusing on the potential role of cerebral microembolic lesions, taking into consideration the impact of factors potentially influencing cognitive status (demographic features, vascular risk profile, neuropsychological evaluation at baseline and magnetic resonance (MR) markers of brain structural damage). Thirty-seven patients with severe carotid artery stenosis were enrolled. Neurological assessment, neuropsychological evaluation and brain MR were performed the day before CAS (E0). Brain MR with DWI was repeated the day after CAS (E1), while neuropsychological evaluation was done after a 14-month median period (E2). Volumes of both white matter hyperintensities and whole brain were estimated at E0 on axial MR FLAIR and T1w-SE sequences, respectively. Unadjusted ANOVA analysis showed a significant CAS ? DWI interaction for MMSE (F = 7.154(32), p = .012). After adjusting for factors potentially influencing cognitive status CAS ? DWI interaction was confirmed for MMSE (F = 7.092(13), p = .020). Patients with DWI lesions showed a mean E2-E0 MMSE reduction of ? 3.1, while group without DWI lesions showed a mean E2-E0 MMSE of + 1.1. Our study showed that peri-procedural brain microembolic load impacts negatively on cognitive functions, independently from the influence of patients-related variables.