Study On The Effect Of Carotid Artery Stenting On Cognitive Impairment Of Patients With Carotid Artery Stenosis And White Matter Lesions

Objective:In this study,the changes of cognitive function in patients with severe stenosis of carotid artery and changes of white matter in different degrees were observed at different stages when before and after carotid artery stenting.Methods:From December 2017 to June 2019,90 patients with severe stenosis of carotid artery in our hospital met the inclusion criteria,and demographic characteristics,risk factors of cerebrovascular disease and combined diseases were recorded.All patients were examined by MRI,CTA and DSA before operation,calculation of the degree of stenosis based on NASCET measurement;The neurological function was assessed by NIHSS score;Classification of white matter lesions according to Fazekas scale,grouping according to the degree of white matter lesions,no white matter lesions(group WML-0): 30 cases,mild and moderate white matter lesions(group WML-1): 30 cases,severe white matter lesions(group WML-2): 30 cases;MOCA scale was used to evaluate the cognitive function of patients with different degrees of white matter damage before and after March and June after CAS.Results:(1)Treatment of 90 internal carotid artery stenosis lesions,90 stents successfully implanted,stent implantation success rate 100%.The degree of stenosis decreased from 87.92± 6.65% to 2.99 ± 3.72%(P < 0.01).(2)Before CAS,compared with WML-0 group,WML-1 group and WML-2 group had significant differences in naming,attention,delayed recall,orientation and MOCA total score(P < 0.05),especially in WML-2 group;In addition,there were significant differences in visual spatial ability and language function between patients with severe stenosis of left and right carotid artery before operation(P < 0.05),the former had a lower score of language function,while the latter had a lower score of visual spatial ability.(3)After CAS,compared with before CAS,there were significant differences in the total score of MOCA and visual spatial ability of WML-0 group(P < 0.05),in this group,the preoperative MOCA score was relatively high,the cognitive function damage wasrelatively light,the cognitive area damage was relatively small,and the postoperative score improvement was relatively small.There were significant differences in total score of MOCA,visual spatial ability,attention,language function and delayed memory in WML-1 group(P <0.05),in this group,the cognitive domain damage was relatively more,and the postoperative cognitive domain improvement was more.There were significant differences in the total score of MOCA,visual spatial ability,naming,attention,language function,delayed memory in WML-2 group(P < 0.05),in this group,the preoperative cognitive area was damaged widely,and the postoperative cognitive area improved the most,and the cognitive level improved more significantly in 6 months after operation than in 3 months after operation;In addition,six months after CAS,the patients with severe stenosis of left and right carotid arteries were compared with those before CAS,the former has a higher score of language function and a tendency of recovery,but there is no significant difference(P > 0.05),the latter has a significant difference in visual spatial ability and language function(P < 0.05),among which visual spatial ability score is significantly higher than before.Conclusion:(1)Multiple cognitive impairments in patients with severe carotid stenosis and white matter lesions,the more severe the damage of white matter,the more serious the cognitive impairment is,the more the field of cognitive impairment is involved.(2)After carotid artery stenting,with or without white matter damage,the overall cognitive level of patients improved gradually,the greater the degree of white matter damage,the more cognitive areas improved,especially the visual spatial ability,naming,attention,speech and delayed recall ability,which can last for at least 6 months.(3)The cognitive impairment in the left and right carotid artery stenosis patients is different,and the cognitive function improvement areas after carotid artery stent implantation are different.