颈动脉支架置入术对颈动脉狭窄所致脑白质疏松与认知功能改变的影响

目的：探讨颈动脉狭窄与脑白质疏松（LA）、认知功能障碍的相关性及颈动脉支架置入术（CAS）后LA与认知功能的变化。方法：选取2014年8月至2017年8月在温州医科大学附属舟山医院经数字减影血管造影检查确诊颈动脉狭窄大于70%的住院患者共44例，支架组、对照组各22例。于治疗前、治疗后6个月行头颅MRI检查，治疗前及治疗后1个月、6个月分别行MMSE、WAIS-RC测验，比较2组的基线及随访结果。结果：控制相关危险因素后，LA体积仍与颈动脉狭窄程度相关（r=0.473，P＜0.05），MMSE得分仍与颈动脉狭窄程度相关（r=-0.330，P＜0.05）。治疗后，支架组LA体积、MMSE得分较对照组明显改善（P＜0.05）。CAS后WAIS-RC得分较术前明显改善，主要体现在算术、数字广度、数字符号、木块图测验。结论：颈动脉狭窄与LA、认知功能相关，狭窄程度越重，LA体积越大，认知障碍越明显。CAS后LA体积缩小，认知功能改善。

The changes of leukoaraiosis and cognitive function after carotid stenosis and carotid artery stenting

Objective: To investigate the correlation between carotid artery stenosis and leukoaraiosis (LA) and cognitive impairment, and the changes of LA and cognitive function after carotid artery stenting (CAS). Methods: The study included 44 hospitalized patients with carotid artery stenosis greater than 70% which were confirmed by digital subtraction angiography from Zhoushan Hospital Affiliated to Wenzhou Medical University during August 2014 to August 2017. All the patients were divided into two groups, with 22 cases in both stenting group and the control group. The Cranial MRI examination was performed at the baseline and six-month follow-up. Before treatment, 1 month after treatment and 6 months after treatment, neuropsychological tests were performed, including Mini-Mental State Examination (MMSE) and Wechsler Adult Intelligence Scale-RC (WAIS-RC). The baseline characteristics and follow-up results were compared in each group. Results: After controlling other risk factors, the volume of LA lesions was still related to the degree of carotid artery stenosis (r=0.473, P<0.05), the score of MMSE was still related to the degree of carotid artery stenosis (r= -0.330, P<0.05). Compared with the control group, the volume of LA lesions and the score of MMSE were both significantly ameliorated in the stent implantation group after treatment (P<0.05). The score of WAIS-RC was significantly improved after operation compared with preoperative, mainly in the arithmetic, digit span, digit symbol, block design test. Conclusion: ①Carotid artery stenosis was related to LA and cognitive dysfunction. The more serious the stenosis is, the greater volume of LA lesions and the more severe of cognitive impairment. ②LA and cognitive function was ameliorated after CAS.