Changes Of Cognitive Function And Brain Function After Carotid Artery Stenting

Part 1Changes of cognitive function after carotid artery stentingObjective To investigate the effect of carotid artery stenting(CAS)on cognitive function based on changes of a battery of neuropsychological tests.Methods Thirty-three patients were included with 17 in the stent-placement group and 16 in the control group,among whom,the severe unilateral or bilateral internal carotid artery stenosis was confirmed by cerebral vascular angiography in the department of Interventional Radiology and Vascular Surgery of Zhongda hospital Southeast University from June 2015 to September 2016.Neuropsychological tests were performed on the baseline and six months follow-up.The baseline characteristics and follow-up changes were compared in each groups.Results The overall cognitive function of the stent-placement group was statistically significantly improved(P<0.05)compared with control group.The difference of Mini-Mental State Examination(MMSE)score before(25.13±2.67)and after CAS(26.6± 1.68)shows statistically significant difference(P=0.01).The difference of Montreal Cognitive Assessment(MoCA)score before(22.73±4.94)and after CAS(26.00±3.70)shows statistically significant difference(P=0.00).The difference of Complex Figure test-delay recall(CFT-delay)score before(14.60±6.91)and after CAS(18.33±5.19)shows statistically significant difference(P=0.02).The difference of Auditory Verb Learning Test(AVLT)score before(5.47±2.88)and after CAS(6.67±1.72)shows statistically significant difference(P=0.03).The difference of Auditory Verb Learning Test-delay recall(AVLT-delay)score before(3.33±2.72)and after CAS(5.07±2.12)shows statistically significant difference(P=0.00).The difference of Frontal Assessment Battery(FAB)score before(3.33±2.72)and after CAS(5.07±2.12)shows statistically significant difference(P=0.01).On the other side,there was no statistically significant difference(P>0.05)between baseline and follow-up results in control group.Conclusion The overall cognitive function of patients with carotid artery stenosis significantly improve after CAS compared with medical treatment,mainly in the executive function,memory,attention and other aspects.Part 2Changes of brain function after carotid artery stentingObjective To investigate the effect of carotid artery stenting(CAS)on brain function based on magnetic resonance imaging.Methods Thirty-three patients were included with 17 in the stent-placement group and 16 in the control group,among whom,the severe unilateral or bilateral internal carotid artery stenosis was confirmed by cerebral vascular angiography in the department of Interventional Radiology and Vascular Surgery of Zhongda hospital Southeast University from June 2015 to September 2016.Rest-state blood oxygenation level dependent fMRI were performed on the baseline and six months follow-up.The baseline characteristics and follow-up changes were compared in each groups.Results The amplitude of low-frequency fluctuation(ALFF)change in stent group showed statistically significant increase(P<0.05,Alphasim correction)in left prefrontal cortex(t=5.86,P<0.05),the somatosensory association cortex in left superior parietal lobe(t=5.60,P<0.05)and bilateral motor cortical area in posterior frontal lobe(t=5.29,P<0.05).The ALFF showed statistically significant decrease(P<0.05,Alphasim correction)in left retrosplenial cingulate cortex(t=-5.59,P<0.05),left insular cortex(t=-6.34,P<0.05),right insular cortex(t=-8.13,P<0.05)and left dorsal anterior cingulate cortex(t=-5.58,P<0.05).There was no statistically significant difference(P>0.05,Alphasim correction)between baseline and follow-up results in control group.Besides,the ALFF change of the left insular cortex(r=-0.59,P=0.03)and bilateral motor cortical area(r=-0.66,P=0.01)was negatively correlated with Auditory Verb Learning Test(AVLT)score change.The ALFF change of bilateral motor cortical area was negatively correlated with the Auditory Verb Learning Test-delay recall(AVLT-delay)score change(r=-0.59,P=0.03).And the ALFF change on right insular cortex and the FAB score change was positively correlated(r=0.64,P=0.03).Conclusion The overall cognitive function of patients with carotid artery stenosis significantly improve after CAS compared with medical treatment.The change of ALFF value in related brain area is also statistically significant.ALFF Change most in area of Default Mode Network(DMN)may suggest a mechanism of postoperative neurological recovery in patients with carotid artery stenosis.