title: Improvement of Cerebral Glucose Metabolism in Symptomatic Patients With Carotid Artery Stenosis After Stenting.
abstract: OBJECTIVE
  Neurocognitive performance among patients with carotid artery stenosis or occlusion may deteriorate because of chronic cerebral hypoperfusion. Carotid artery stenting (CAS) has been reported to improve cerebral perfusion and neurocognitive function. The purpose of the study was to evaluate cerebral metabolism using F-fluorodeoxyglucose (FDG) positron emission tomography (PET) after CAS.
  
  
  METHODS
  Nineteen consecutive patients (15 men, 69 ± 13 years) with carotid artery stenosis or occlusion and cerebral ischemia detected on brain perfusion computed tomography (CT) or magnetic resonance imaging (MRI) were enrolled. Four patients had bilateral lesions, and 15 subjects had previous ischemic stroke. Neurocognitive function (NCF) assessments and brain FDG PET scans were performed before and 19 ± 7 (12-31) months after the procedure.
  
  
  RESULTS
  The procedural success rate of CAS was 70%. Two patients were excluded from the study because of procedural complications. No new cerebral ischemic events or neurologic deaths occurred during follow-up of 44 ± 11 (15-54) months. Significant improvements were observed in the Mini-Mental State Examination (before, 26.06 ± 3.32 versus after, 28.13 ± 2.8; P = 0.0016), the verbal fluency test (26.81 ± 7.82 versus 30.75 ± 9.58; P = 0.0378), and marginal upgrading in the Alzheimer Disease Assessment Scale-Cognitive Subtest (7.19 ± 7.59 versus 5.63 ± 5.90; P = 0.0523). Six of 9 patients who underwent successful CAS showed improvement of cerebral glucose metabolism. Of the 4 patients with recanalization failure, 2 exhibited decline in ipsilateral glucose metabolism. Cerebral FDG metabolism improved in patients with successful CAS (P = 0.038), although there was a weak correlation between interval change of NCF tests and brain FDG metabolism.
  
  
  CONCLUSIONS
  Successful CAS may improve long-term cerebral glucose metabolism and neurocognitive function in patients with chronic severe carotid stenosis or occlusion.
authors.affiliation: From the Departments of *Internal Medicine, †Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei; ‡Graduate Institute of Oncology, National Taiwan University, Taipei; §Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei; ∥Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City; ¶Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei; #Department of Cardiology, Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City; **National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China.
authors.forename: Hsien-Li
authors.initials: HL
authors.lastname: Kao
authors.forename: Mao-Shin
authors.initials: MS
authors.lastname: Lin
authors.forename: Wen-Chau
authors.initials: WC
authors.lastname: Wu
authors.forename: Wen-Yih I
authors.initials: WY
authors.lastname: Tseng
authors.forename: Mao-Yuan
authors.initials: MY
authors.lastname: Su
authors.forename: Ya-Fang
authors.initials: YF
authors.lastname: Chen
authors.forename: Ming-Jang
authors.initials: MJ
authors.lastname: Chiu
authors.forename: Shan-Ying
authors.initials: SY
authors.lastname: Wang
authors.forename: Wei-Shiung
authors.initials: WS
authors.lastname: Yang
authors.forename: Kai-Yuan
authors.initials: KY
authors.lastname: Tzen
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Wu
authors.forename: Ming-Fong
authors.initials: MF
authors.lastname: Chen
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D002540:Cerebral Cortex / Q000000981:diagnostic imaging*; D003071:Cognition; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D015607:Stents
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005947:Glucose