Cognition and Hemodynamics after Carotid Endarterectomy for Asymptomatic Stenosis

Česká verzia

Authors: J. Fiedler ^1–3; T. Mrhálek ⁴; M. Vavrečka ⁴; S. Ostrý ¹; M. Bombic ¹; J. Kubále ⁵; V. Přibáň ³; M. Preiss ⁶; I. Stuchlíková ⁴
Authors place of work: Neurochirurgické oddělení, Nemocnice České Budějovice a. s. ¹; Neurochirurgická klinika LF MU a FN Brno ²; Neurochirurgická klinika LF UK a FN Plzeň ³; Katedra pedagogiky a psychologie, Jihočeská univerzita, České Budějovice ⁴; Radiologické oddělení, Nemocnice České Budějovice a. s. ⁵; Psychiatrické centrum Praha ⁶
Published in the journal: Cesk Slov Neurol N 2016; 79/112(2): 201-206
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2016201

Práce vznikla za podpory grantu CZ.1.07/2.3.00/30.0049 a MZ ČR – RVO (Fakultní nemocnice Plzeň – FNPl, 00669806).

Summary

Aim:
To test a brain haemodynamics examination protocol using magnetic resonance imaging and to investigate the differences in cognitive performance with a neuropsychology test battery RBANS (Repeatable Battery for the Assessment of Neuropsychological Status) on a cohort of patients with an asymptomatic carotid stenosis undergoing carotid endarterectomy.

Methods:
Standard carotid endarterectomy in asymptomatic carotid stenosis under general intravenous anaestehesia with selective use of a shunt. Flow measurement in major vessels of the Willis circle using magnetic resonance angiography with phase contrast before and three months after the operation and concurrently with RBANS psychological examination testing battery.

Results:
Significant cognitive performance improvement in neuropsychological test battery total score and in short-term memory (p = 0.04) and speech (p = 0.01) indexes was seen in five women and 12 men undergoing uncomplicated carotid endarterectomy. Subsequent correlations of local haemodynamic change and cognitive performance change in 12 patients were significant for the anterior cerebral artery and immediate memory index (p = 0.01), and for the medial cerebral artery and speech indeces (p = 0.02) and visuospatial orientation (p = 0.02).

Conclusion:
In a pilot study, a flow (ml/min) examination protocol of all major Willis circle arteries was tested and haemodynamic changes before the operation and in three months follow-up after carotid endarterectomy were compared on a small group of patients with radiologically and clinically asymptomatic carotid stenosis for the first time in Czech literature. Improvement in cognitive performance was demonstrated and an association with anterior or medial cerebral artery flow values was identified in individual RBANS tests. A larger study with a longer follow-up is feasible.

Key words:
carotid artery atherosclerosis – carotid artery stenosis – carotid endarterectomy – cognition – neuropsychology

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

1. Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics – 2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007;115(5):e69– 171.

2. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325(7):445– 53.

3. European Carotid Surgery Trialists‘ Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70– 99%) or with mild (0– 29%) carotid stenosis. Lancet 1991;337(8752):1235– 43.

4. The European Stroke Organisation (ESO) Executive Commitee and the ESO writing Commiteee. ESO guidelines for management of ischaemic stroke – update 2009. Available from URL: http:/ / www.eso-stroke.org/ pdf/ ESO_Guidelines_CZ.pdf.

5. Executive Committee for the ACAS. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995;273(18):1421– 8.

6. Halliday A, Mansfield A, Marro J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet 2004;363(9432):1491– 502.

7. Lunn S, Crawley F, Harrison MJ, et al. Impact of carotid endarterectomy upon cognitive functioning. A systomatic review of the literature. Cerebrovasc Dis 1999;9(2):74– 81.

8. Markus HS, King A, Shipley M, et al. Asymptomatic embolisation for prediction of stroke in the Asymptomatic Carotid Emboli Study (ACES): a prospective observational study. Lancet Neurol 2010;9(7):663– 71. doi: 10.1016/ S1474-4422(10)70120-4.

9. King A, Serena J, Bornstein NM, et al. Does impaired cerebrovascular reactivity predict stroke risk in asymptomatic carotid stenosis? A prospective substudy of the asymptomatic carotid emboli study. Stroke 2011;42(6):1550– 5. doi: 10.1161/ STROKEAHA.110.609057.

10. Amarenco P, Boguousslavsky J, Callahan A, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006;355(6):549– 59.

11. ACST-2 Collaborative Group. Status update and interim results from the asymptomatic carotid surgery trial-2 (ACST-2). Eur J Vasc Endovasc Surg 2013;46(5):510– 8. doi: 10.1016/ j.ejvs.2013.07.020.

12. Fiedler J, Přibáň V, Škoda O, et al. Cognitive outcome after EC-IC bypass surgery in hemodynamic cerebral ischemia. Acta Neurochir (Wien) 2011;153(6):1303– 12. doi: 10.1007/ s00701-011-0949-x.

13. Ghogawala Z, Westerveld M, Amin-Hanjani S. Cognitive outcomes after carotid revascularisation: the role of cerebral emboli and hypoperfusion. Neurosurgery 2008;62(2):385– 95. doi: 10.1227/ 01.neu.0000316005. 88517.60.

14. Irwine CD, Gardner FV, Davies AH, et al. Cognitive testing in patients undergoing carotid endarterectomy. Eur J Vasc Endovasc Surg 1998;15(3):195– 204.

15. Hořínek D, Urbanová B, Netuka D, et al. Kognitivní funkce při onemocnění vnitřní krkavice a vliv léčebných intervencí. Cesk Slov Neurol N 2011;74/ 107(3):254– 9.

16. Randolph C. Repeatable battery for the assessment of neuropsychological status. San Antonio (TX): The Psychological Coporation 1998.

17. Ghogawala Z, Amin-Hanjani S, Curran J, et al. The effect of carotid endarterectomy on cerebral blood flow and cognitive function. J Stroke Cerebrovasc Dis 2013;22(7):1029– 37. doi: 10.1016/ j.jstrokecerebrovasdis.2012.03.016.

18. Sokol D, Fiedler J, Chlouba V, et al. Endarterectomy for asymptomatic carotid artery stenosis under local anaesthesia. Acta Neurochir (Wien) 2011;153(2):363– 9. doi: 10.1007/ s00701-010-0806-3.

19. Beneš V, Mohapl M, Zoul J. Karotická endarterektomie z pohledu neurochirurga. Cesk Slov Neurol N 1998;61/ 94(1):27– 36.

20. Sameš M, Provazníková E, Cihlář F, et al. Peroperační monitoring aktivovaného koagulačního času při karotické endarterektomii. Cesk Slov Neurol N 2011;74/ 107(3):325– 9.

21. Bowie C, Harvey P. Administration and interpretation of the trail making test. Nature Protocols 2006;1(5):2277– 81.

22. Douglas AF, Christopher S, Amankulov N, et al. Extracranial carotid plaque length and parent vessel diameter significantly affect baseline ipsilateral intracranial blood flow. Neurosurgery 2011;69(4):767– 73. doi: 10.1227/ NEU.0b013e31821ff8f4.

23. Duff K, Hobson VL, Beglinger LJ, et al. Diagnostic accuracy of the RBANS in mild cognitive impairment: limitations on assessing milder impairments. Arch Clin Neuropsychol 2010;25(5):429– 41. doi: 10.1093/ arclin/ acq045.

24. Sztriha LK, Nemeth D, Sefcsik T, et al. Carotid stenosis and the cognitive function. J Neurol Sci 2009;283(1– 2):36– 40. doi: 10.1016/ j.jns.2009.02.307.

25. Plessers M, van Herzeele I, Vermassen F, et al. Neurocogntive functioning after carotid revascularization: a systematic review. Cerebravasc Dis Extra 2014;4(2):132– 48. doi: 10.1159/ 000362921.

26. Lunn S, Crawley F, Harrison MJ, et al. Impact of carotid endarterectomy upon cognitive functioning. A systematic review of the literature. Cerebrovasc Dis 1999;9(2):74– 81.

27. Saito H, Ogsawara K, Nishimoto H, et al. Postoperative changes in cerebral metabolites associated with cognitive improvement and impairment after carotid endarterectomy: a 3T proton MR spectroscopy study. AJNR Am J Neuroradiol 2013;34(5):976– 82. doi: 10.3174/ ajnr.A3344.