Effects of Carotid Endarterectomy on Cerebral Reperfusion and Cognitive Function in Patients with High Grade Carotid Stenosis: A Perfusion Weighted Magnetic Resonance Imaging Study.
OBJECTIVE
To investigate the influence of carotid endarterectomy (CEA) on cerebral perfusion and cognitive function in patients with internal carotid artery stenosis (ICA).


METHODS
Patients were prospectively enrolled in this study. Shunted patients were excluded. Cerebral perfusion was measured by magnetic resonance (MR) perfusion weighted imaging (PWI) and diffusion weighted imaging (DWI) in 46 patients with >65% ICA (31 males, 64.5 ± 6.7 years) 1 week before and 6 weeks after CEA. Cognitive function was assessed using the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) 1 week before and 6 weeks after CEA.


RESULTS
After CEA, perfusion parameters from PWI decreased, including mean transit time (MTT) (21.07 ± 7.36 vs. 14.27 ± 6.22, p < .0001), time to peak (TTP) (28.69 ± 8.54 vs. 23.45 ± 4.25, p = .001), arrive time (T0) (19.89 ± 7.32 vs. 15.20 ± 3.51, p = .001), and relative cerebral blood volume (rCBV) (11.48 ± 3.50 vs. 7.53 ± 3.17, p < .0001). A significant improvement was observed in MoCA (20.48 ± 1.70 vs. 22.04 ± 1.48, p = .001). Spearman's rank correlation analysis between TTP and MoCA scores demonstrated a linear relationship with an excellent correlation coefficient (R = -.893, p < .001). Linear regression indicated that diabetes was a risk factor for cognitive improvement in patients with ICA (p = .014). Further analysis showed that patients with DM performed worse in MoCA after the procedure (with-DM 21.15 ± 1.28 vs. non-DM 22.4 ± 1.46, p = .010) while the baselines were similar (non-DM: 20.3 ± 1.8 vs. with-DM: 20.9 ± 1.4, p = .362).


CONCLUSIONS
CEA could improve the cerebral perfusion and the cognitive function in un-shunted ICA patients. Cerebral reperfusion was an important factor for cognitive improvement. Diabetes had a negative effect on cognitive improvement after CEA.
Department of Vascular Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, PR China.
Q
Q
Wang
Department of Vascular Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, PR China.
M
M
Zhou
Department of Vascular Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, PR China.
Y
Y
Zhou
Department of Vascular Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, PR China.
J
J
Ji
Department of Vascular and Endovascular Surgery, Nuremberg Southern Hospital, Nuremberg, Germany.
D
D
Raithel
Department of Vascular Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, PR China. Electronic address: qiaotongmail@aliyun.com.
T
T
Qiao
D016893:Carotid Stenosis / Q000503:physiopathology* / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003071:Cognition / Q000502:physiology*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index
Carotid endarterectomy; Carotid stenosis; Cognitive function; Perfusion weighted imaging