Effect Analysis Of Intracranial Artery Stenting On Cognitive Function

Purpose:(1)To evaluate cognitive function before and after intracranial artery stenting in patients with symptomatic intracranial stenosis and cognitive dysfunction using MoCA and compare the different effects on cognitive function in hospitalization and follow-up periods between intracranial stenting combined with drugs therapy and drugs therapy alone.(2)To compare the different effects on the cognitive function after stent combined with drug treatment in different collateral circulation status.Method:Patients with symptomatic intracranial stenosis from Augest,2017 to Augest,2019 in hospitalization of department of Neurology and Neurological Intervention of the Affiliated Hosipital of Qingdao university were analyzed.According to inclusion criteria and exclusion criteria,98 cases were finally included and divided into two groups(55cases in intracranial stenting combined with drugs group and 43 cases in drugs alone group).Cognitive function of all patients were assessed by method of MoCA in three time points(in hospitalization,1 month and 6 months at follow-up)in order to evaluate the difference of two treatments on cognitive function.As to stenting combined with drugs group,subgroup analysis was conducted based on different perioperative collateral circulation status for purpose to evaluate the effect of collateral circulation status on cognitive function.Outcome:1.(1)Our study suggested the score of total MoCA(P=0.001),delayed recall(P<0.001)and drawing clock(P=0.012)had statistical significance during 6-m-onth follow-up between two groups,which indicated the three scores above could obtain more benefit in stent group than drugs group.(2)Further comparison of different time points within each group,firstly,drugs group couldn't improved the level of cognitive function.Then the scores of total MoCA,drawing clock,delayed recall and line connection test could be improved in stenting combined with drugs group(all P<0.05).Among them,the scores of total MoCA,drawing clock and delayed recall gradually improved during the follow-up period and The increase in score of line connection test is mainly concentrated within 1month of the follow-up period.(3)Different stent sites have nothing to do with the improvement rate of benefit score items(MoCA total score,line connection,drawing clock,attention,and delayed recall)in stenting combined with drugs group;preoperative poor collateral circulation status can improve the improvement rate of MoCA total score(c~2=6.061,P=0.014),drawing clock(c~2=5.123,P=0.024),attention(c~2=4.969,P=0.026),and delayed recall(c~2=4.969,P=0.026)at 1 month follow-up.2.2.(1)In subgroup analysis,the study found that both groups could benefit from cognitive function during the follow-up period.It suggested the score of total MoCA(P=0.008)and drawing clock(P=0.002)had statistical significance during 6-month3.follow-up between two different collateral states.However,the reason for the significance above was the different baseline scores in hospitalization of total MoCA(P<0.001)and drawing clock(P=0.002).(2)Further comparison of different time points within each group,the scores of total MoCA(P=0.001),attention(P=0.002),delayed recall(P=0.002)could be improved in good collateral circulation group and the improvement mainly occurred within the period from 1-month to 6-month follow-up.The scores of total MoCA(P=0.001),attention(P<0.001),drawing clock(P<0.001),delayed recall(P<0.001),sentence repetition(P=0.017)and line connection(P<0.001)could be improved in poor collateral circulation group and the improvement mainly occurred within the first month follow-up period.Conclusion:(1)The cognitive function in paitents with symptomatic intracranial stenosis and cognitive dysfunction could be benefit from intracranial stenting combined with drugs therapy during 6-month follow-up.Compared to drugs group,there are more advantages on improving overall cognitive level(total MoCA score),ability of delayed recall and partial visual space execution and motor integration capabilities(drawing clock score)in stent group.(2)Patients with both different preoperative collateral circulation status can benefit from cognitive function after stenting.But the benefit period of cognitive function is different.In the follow-up period of 6 months,time to cognitive benefit was earlier in poor collateral circulation paitents than in good ones.