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中华脑血管病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 194 -198. doi: 10.11817/j.issn.1673-9248.2020.04.002

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颈动脉狭窄认知功能障碍机制及颈动脉血运重建术对认知功能影响的研究进展
霍然1, 刘颖1, 邬海博1, 徐慧敏1, 王涛2,(), 袁慧书1,()   
  1. 1. 100191 北京大学第三医院放射科
    2. 100191 北京大学第三医院神经外科
  • 收稿日期:2020-02-14 出版日期:2020-08-01
  • 通信作者: 王涛, 袁慧书
  • 基金资助:
    北京市自然科学基金面上项目(7192219); 北京大学第三医院临床重点项目(BYSY2015013)

The advance of the mechanism of cognitive impairment in patients with carotid stenosis and the effects of carotid revascularization on cognitive function

Ran Huo1, Ying Liu1, Haibo Wu1, Huimin Xu1, Tao Wang2,(), Huishu Yuan1,()   

  1. 1. Department of Radiology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-02-14 Published:2020-08-01
  • Corresponding author: Tao Wang, Huishu Yuan
  • About author:
    Corresponding author: Yuan Huishu, Email:
    Wang Tao, Email:
引用本文:

霍然, 刘颖, 邬海博, 徐慧敏, 王涛, 袁慧书. 颈动脉狭窄认知功能障碍机制及颈动脉血运重建术对认知功能影响的研究进展[J]. 中华脑血管病杂志(电子版), 2020, 14(04): 194-198.

Ran Huo, Ying Liu, Haibo Wu, Huimin Xu, Tao Wang, Huishu Yuan. The advance of the mechanism of cognitive impairment in patients with carotid stenosis and the effects of carotid revascularization on cognitive function[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2020, 14(04): 194-198.

随着人口老龄化及卒中危险因素的加剧,脑卒中成为我国成人致死、致残的首位原因。颈动脉粥样硬化性狭窄是成人缺血性脑卒中的主要原因,也是引起认知功能障碍的独立危险因素。颈动脉血运重建术(包括颈动脉内膜切除术和颈动脉支架植入术)能够降低颈动脉狭窄患者远期卒中风险和改善认知功能障碍。本文就颈动脉狭窄所致认知功能障碍机制及颈动脉血运重建术对认知功能的影响进行综述。

Stroke is still the leading cause of the mortality and disability of Chinese adults with the aging of society and the deterioration of cardiovascular risk factors. Carotid stenosis is the main cause of adult ischemic strokes and an independent risk factor of cognitive disorders. Carotid revascularization, including carotid endarterectomy (CEA) and carotid artery stenting (CAS), contributes to decreasing the long-term stroke risk and improving the impaired cognitive function in patients with carotid stenosis. In this article, we reviewed the mechanism of cognitive disorders caused by carotid stenosis and the effects of carotid revascularization on cognitive function.

1
Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the global burden of disease study 2017 [J]. Lancet, 2019, 394(10204): 1145-1158.
2
Chaturvedi S, Bruno A, Feasby T, et al. Carotid endarterectomy-an evidence-based review: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology [J]. Neurology, 2005, 65(6):794-801.
3
Kolominsky-Rabas PL, Weber M, Gefeller O, et al. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study [J]. Stroke, 2001, 32(12): 2735-2740.
4
王陇德, 刘建民, 杨弋, 等. 我国脑卒中防治仍面临巨大挑战——《中国脑卒中防治报告2018》概要 [J]. 中国循环杂志, 2019, 34(2): 105-119.
5
中华医学会外科学分会血管外科学组. 颈动脉狭窄诊治指南 [J]. 中华血管外科杂志, 2017, 2(2): 169-175.
6
Fisher M. Senile dementia-a new explanation of its causation [J]. Can Med Assoc J, 1951, 65(1): 1-7.
7
Del Brutto OH, Mera RM, Recalde BY, et al. Carotid intima-media thickness, cognitive performance and cognitive decline in stroke-free middle-aged and older Adults. The Atahualpa Project [J]. J Stroke Cerebrovasc Dis, 2020, 29(2): 104576.
8
Moon JH, Lim S, Han JW, et al. Carotid intima-media thickness is associated with the progression of cognitive impairment in older adults [J]. Stroke, 2015, 46(4): 1024-1030.
9
Mathiesen EB, Waterloo K, Joakimsen O, et al. Reduced neuropsychological test performance in asymptomatic carotid stenosis: the Tromso Study [J]. Neurology, 2004, 62(5): 695-701.
10
Norling AM, Marshall RS, Pavol MA, et al. Is hemispheric hypoperfusion a treatable cause of cognitive impairment? [J]. Curr Cardiol Rep, 2019, 21(1): 4.
11
Haratz S, Weinstein G, Molshazki N, et al. Impaired cerebral hemodynamics and cognitive performance in patients with atherothrombotic disease [J]. J Alzheimer's Dis, 2015, 46(1): 137-144.
12
Cechetti F, Pagnussat AS, Worm PV, et al. Chronic brain hypoperfusion causes early glial activation and neuronal death, and subsequent long-termmemory impairment [J]. Brain Res Bull, 2012, 87(1): 109-116.
13
Kim JH, Ko PW, Lee HW, et al. Astrocyte-derived lipocalin-2 mediates hippocampal damage and cognitive deficits in experimental models of vascular dementia [J]. Glia, 2017, 65(9): 1471-1490.
14
Haratz S, Weinstein G, Molshazki N, et al. Impaired cerebral hemodynamics and cognitive performance in patients with atherothrombotic disease [J]. J Alzheimer's Dis, 2015, 46(1): 137-144.
15
Ruitenberg A, den Heijer T, Bakker SL, et al. Cerebral hypoperfusion and clinical onset of dementia: the Rotterdam study [J]. Ann Neurol, 2005, 57(6): 789-794.
16
Xie S, Hui LH, Xiao JX, et al. Detecting misery perfusion in unilateral steno-occlusive disease of the internal carotid artery or middle cerebral artery by MR imaging [J]. AJNR Am J Neuroradiol, 2011, 32(8): 1504-1509.
17
Yamauchi H, Fukuyama H, Nagahama Y, et al. Atrophy of the corpus callosum associated with cognitive impairment and widespread cortical hypometabolism in carotid artery occlusive disease [J]. Arch Neurol, 1996, 53(11): 1103-1109.
18
Sabat J, Bock D, Hsu CH, et al. Risk factors associated with microembolization after carotid intervention [J]. J Vasc Surg, 2019. pii: S0741-5214(19)31798-7.
19
Mitchell CC, Wilbrand SM, Kundu B, et al. Transcranial doppler and microemboli detection: relationships to symptomatic status and histopathology findings [J]. Ultrasound Med Biol, 2017, 43(9): 1861-1867.
20
Ritter MA, Dittrich R, Thoenissen N, et al. Prevalence and prognostic impact of microembolic signals in arterial sources of embolism. A systematic review of the literature [J]. J Neurol, 2008, 255(7): 953-961.
21
Rapp JH, Pan XM, Sharp FR, et al. Atheroemboli to the brain: size threshold for causing acute neuronal cell death [J]. J Vasc Surg, 2000, 32(1): 68-76.
22
Miwa K, Hoshi T, Hougaku H, et al. Silent cerebral infarction is associated with incident stroke and TIA independent of carotid intima-media thickness [J]. Intern Med, 2010, 49(9): 817-822.
23
Vermeer SE, Prins ND, den Heijer T, et al. Silent brain infarcts and the risk of dementia and cognitive decline [J]. N Engl J Med, 2003, 348(13): 1215-1222.
24
Howard G, Roubin GS, Jansen O, et al. Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomized trials [J]. Lancet, 2016, 387(10025): 1305-1311.
25
Cho SM, Deshpande A, Pasupuleti V, et al. Radiographic and symptomatic brain ischemia in CEA and CAS: A systematic review and meta-analysis [J]. Neurology, 2017, 89(19): 1977-1984.
26
Vincent S, Eberg M, Eisenberg MJ, et al. Meta-analysis of randomized controlled trials comparing the long-term outcomes of carotid artery stenting versus endarterectomy [J]. Circ Cardiovasc Qual Outcomes, 2015, 8(6 Suppl 3): S99-S108.
27
Naylor AR, Ricco JB, de Borst GJ, et al. Management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the european society for vascular surgery (ESVS) [J]. Eur J Vasc Endovasc Surg, 2018, 55(1): 3-81.
28
Asken MJ, Hobson RW. Intellectual change and carotid endarterectomy, subjective speculation or objective reality: a review [J]. J Surg Res, 1977, 23(5): 367-375.
29
Goldberg JB, Goodney PP, Kumbhani SR, et al. Brain injury after carotid revascularization: outcomes, mechanisms, and opportunities for improvement [J]. Ann Vasc Surg, 2011, 25(2): 270-286.
30
Borroni B, Tiberio G, Bonardelli S, et al. Is mild vascular cognitive impairment reversible? Evidence from a study on the effect of carotid endarterectomy [J]. Neurol Res, 2004, 26(5): 594-597.
31
Song LP, Zhang WW, Gu YQ, et al. Cognitive improvement after carotid artery stenting in patients with symptomatic internal carotid artery near-occlusion [J]. J Neurol Sci, 2019, 404: 86-90.
32
Shi GM, Jiang T, Zhang H, et al. Carotid endarterectomy and carotid artery stenting lead to improved cognitive performance in patients with severe carotid artery stenosis [J]. Curr Neurovasc Res, 2016, 13(1): 45-49.
33
张红刚, 张雯, 周楚, 等. 颈动脉内膜斑块切除术改善血管性认知障碍的影响因素研究 [J]. 中华医学杂志, 2019, 99(4): 260-265.
34
刘华坤, 王鹏, 张磊, 等. 介入血运重建改善颈动脉次全闭塞伴轻卒中患者认知障碍的研究 [J/CD]. 中华脑科疾病与康复杂志(电子版), 2019, 9(4): 227-230.
35
Wang T, Sun D, Liu Y, et al. The impact of carotid artery stenting on cerebral Perfusion, Functional connectivity, and cognition in severe asymptomatic carotid stenosis Patients [J]. Front Neurol, 2017, 8: 403.
36
Wang Q, Zhou M, Zhou Y, et al. Effects of carotid endarterectomy on cerebral reperfusion and cognitive function in patients with high grade carotid stenosis: a perfusion weighted Magnetic Resonance Imaging study [J]. Eur J Vasc Endovasc Surg, 2015, 50(1): 5-12.
37
Ghogawala Z, Amin-Hanjani S, Curran J, et al. The effect of carotid endarterectomy on cerebral blood flow and cognitive function [J]. J Stroke Cerebrovasc Dis, 2013, 22(7): 1029-1037.
38
Sato Y, Ito K, Ogasawara K, et al. Postoperative increase in cerebral white matter fractional anisotropy on diffusion tensor Magnetic Resonance Imaging is associated with cognitive improvement after uncomplicated carotid endarterectomy: tract-based spatial statistics snalysis [J]. Neurosurgery, 2013, 73(4): 592-598.
39
Porcu M, Craboledda D, Garofalo P, et al. Connectometry evaluation in patients undergoing carotid endarterectomy: an exploratory study [J]. Brain Imaging Behav, 2019, 13(6): 1708-1718.
40
Huang KL, Chang TY, Ho MY, et al. The correlation of asymmetrical functional connectivity with cognition and reperfusion in carotid stenosis patients [J]. Neuroimage Clin, 2018, 20(8): 476-484.
41
Porcu M, Craboledda D, Garofalo P, et al. Reorganization of brain networks following carotid endarterectomy: an exploratory study using resting state functional connectivity with a focus on the changes in Default Mode Network connectivity [J]. Eur J Radiol, 2019, 110(12): 233-241.
42
Tani N, Yaegaki T, Nishino A, et al. Functional connectivity analysis and prediction of cognitive change after carotid artery stenting [J]. J Neurosurg, 2018, 131(6): 1709-1715.
43
Aharon-Peretz J, Tomer R, Gabrieli I, et al. Cognitive performance following endarterectomy in asymptomatic severe carotid stenosis [J]. Eur J Neurol, 2003, 10(5): 525-528.
44
Lehrner J, Willfort A, Mlekusch I, et al. Neuropsychological outcome 6 months after unilateral carotid stenting [J]. J Clin Exp Neuropsychol, 2005, 27(7): 859-866.
45
Bossema ER, Brand AN, Geenen R, et al. Effect of carotid endarterectomy on patient evaluations of cognitive functioning and mental and physical health [J]. Ann Vasc Surg, 2005, 19(5):673-677.
46
Bossema ER, Brand N, Moll FL, et al. Does carotid endarterectomy improve cognitive functioning? [J]. J Vasc Surg, 2005, 41(5): 775-781.
47
Knopman DS, Mosley TH, Catellier DJ, et al. Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: the ARIC MRI Study [J]. Alzheimers Dement, 2009, 5(3): 207-214.
48
Hitchner E, Baughman BD, Soman S, et al. Microembolization is associated with transient cognitive decline in patients undergoing carotid interventions [J]. J Vasc Surg, 2016, 64(6): 1719-1725.
49
Zhou W, Baughman BD, Soman S, et al. Volume of subclinical embolic infarct correlates to long-term cognitive changes following carotid revascularization [J]. J Vasc Surg, 2017, 65(3): 686-694.
50
Zhang HP, Ma XD, Chen LF, et al. Cognitive function after carotid endarterectomy: early decline and later recovery [J]. Turk Neurosurg, 2016, 26(6): 833-839.
51
Nanba T, Ogasawara K, Nishimoto H, et al. Postoperative cerebral white matter damage associated with cerebral hyperperfusion and cognitive impairment after carotid endarterectomy: a diffusion tensor Magnetic Resonance Imaging study [J]. Cerebrovasc Dis, 2012, 34(5-6): 358-367.
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