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Correlation between Higher Brain Dysfunction and Cerebral Blood Flow after Carotid Artery Stenting
Ryousuke Orimoto1, Eiichi Kobayashi2, Midori Abe3
1Kimitsu Central Hospital, Kisarazu, Chiba, Japan.
Insights
Carotid artery stenting (CAS) improved higher brain function, particularly attention and working memory. Improvements correlated with cerebral blood flow (CBF) in specific patient groups, with no impact from diffusion-weighted imaging (DWI) spots.
Area of Science:
- Neurology
- Vascular Surgery
- Neuroimaging
Background:
- Carotid artery stenting (CAS) is a procedure to treat carotid artery stenosis.
- Changes in higher brain function and cerebral blood flow (CBF) after CAS require further investigation.
- The impact of diffusion-weighted imaging (DWI) findings post-CAS on cognitive function is not well understood.
Purpose of the Study:
- To investigate changes in higher brain function and CBF following CAS.
- To explore the relationship between cognitive improvements and CBF.
- To assess the impact of high-intensity DWI spots on cognitive outcomes after CAS.
Main Methods:
- CAS was performed on 88 patients between September 2017 and September 2019.
- Higher brain function tests (Symbol Digit Modalities Test, Kana Pick-out Test II, Mini-Mental State Examination) were administered to 26 patients before, 1 week after, and 1-3 months after CAS.
- Correlation analysis was performed between cognitive changes, CBF, DWI findings, and patient characteristics.
Main Results:
- Significant improvements were observed in Symbol Digit Modalities Test and Kana Pick-out Test scores post-CAS.
- Higher brain function, specifically attention and working memory, showed significant improvement.
- A significant correlation was found between improved higher brain function and CBF in patients with severe stenosis (>60%), a Mini-Mental State Examination score ≤26, and no known dementia.
- High-intensity DWI spots after CAS did not significantly impact higher brain function.
Conclusions:
- CAS leads to significant improvements in higher brain function, including attention and working memory.
- Cognitive enhancement post-CAS is linked to improved CBF, particularly in patients with severe stenosis and mild cognitive impairment without dementia.
- Both prevention of ischemic events and preservation of higher brain function are critical considerations during CAS procedures.
Objective:
This study investigated the changes in higher brain function and cerebral blood flow (CBF) after carotid artery stenting (CAS), the relationship with CBF, and the impact of high intensities in diffusion-weighted imaging (DWI) after CAS.
Methods:
We performed CAS between September 2017 and September 2019 in our department in 88 patients. Patients who did not undergo higher brain function tests according to our protocol or those who did not consent to participate in our study were excluded. This study targeted the 26 patients who were able to undergo the tests, including the Kana Pick-out Test (KPOT) II, three times: before, 1 week after, and 1-3 months after CAS. We investigated the chronological changes in higher brain function and their relationship with high intensity on DWI.
Results:
The results of Symbol Digit Modalities Tests (SDMT) and KPOT I and II improved significantly. There was a significant correlation between the improvement of higher brain function and CBF in patients with stenosis exceeding 60%, a score of the Mini-Mental State Examination (MMSE) of 26 or less, and without other cause of higher brain dysfunction, including known dementia. High-intensity spots on DWI after CAS had no significant impact on higher brain function.
Conclusion:
Higher brain function associated with attention and working memory improved significantly after CAS. There was a correlation between the improvement of higher brain function and CBF in patients with severe stenosis, mild cognitive impairment, and no known dementia. The prevention of subsequent ischemic attack and higher brain function should both be taken into account when performing CAS.
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