Carotid endarterectomy improves cognitive function in patients with exhausted cerebrovascular reserve

被引:70
作者
Fearn, SJ
Hutchinson, S
Riding, G
Hill-Wilson, G
Wesnes, K
McCollum, CN
机构
[1] S Manchester Univ Hosp, Dept Surg, Educ & Res Ctr, Manchester M20 2LR, Lancs, England
[2] Cognit Drug Res Ltd, Reading, Berks, England
关键词
carotid endarterectomy; cognitive function; cerebrovascular reactivity;
D O I
10.1016/S1078-5884(03)00384-8
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective. To investigate changes in cognitive function following carotid endarterectomy (CEA). Design. Prospective study with controls. Methods. CEA patients (n = 159) were compared to a urology surgery control group (n = 20). In CEA patients cerebrovascular reserve (CVR) was measured preoperatively. During surgery emboli and blood flow velocity in the middle cerebral artery were measured by transcranial Doppler (TCD) and cerebral oxygen saturation (CsO2) by near infrared spectroscopy. Cognitive function was measured preoperatively and at 5 days and 8 weeks postoperatively using a standardised computer battery of tests. Results. Only 8% of patients had normal CVR bilaterally. The median number of emboli during CEA was 12 (range 0181). On carotid clamping, TCD velocity fell a median of 41% and cerebral oxygen saturation by 5%. Attention deteriorated compared to controls 5 days following CEA (p = 0.003) and this deterioration was related to the rise in TCD velocity on declamping (r = -0.3, p = 0.002). Median attention reaction times improved significantly by 8 weeks (p = 0.001) especially in patients' with severely impaired CVR before surgery (p = 0.02). Conclusions. Attention improved at 2 months following CEA in patients with impaired CVR. CEA may offer more than reduced stroke risk to patients with impaired CVR.
引用
收藏
页码:529 / 536
页数:8
相关论文
共 34 条
[1]  
BISHOP CCR, 1986, LANCET, V1, P710
[2]   A COMPARISON OF TRANSCRANIAL DOPPLER AND CEREBRAL BLOOD-FLOW STUDIES TO ASSESS CEREBRAL VASOREACTIVITY [J].
DAHL, A ;
LINDEGAARD, KF ;
RUSSELL, D ;
NYBERGHANSEN, R ;
ROOTWELT, K ;
SORTEBERG, W ;
NORNES, H .
STROKE, 1992, 23 (01) :15-19
[3]   Cerebral hypoperfusion yields capillary damage in the hippocampal Ca1 area that correlates with spatial memory impairment [J].
De Jong, GI ;
Farkas, E ;
Stienstra, CM ;
Plass, JRM ;
Keijser, JN ;
De la Torre, JC ;
Luiten, PGM .
NEUROSCIENCE, 1999, 91 (01) :203-210
[4]   Cerebral injury during cardiopulmonary bypass: Emboli impair memory [J].
Fearn, SJ ;
Pole, R ;
Wesnes, K ;
Faragher, EB ;
Hooper, TL ;
McCollum, CN .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2001, 121 (06) :1150-1160
[5]   Should heparin be reversed after carotid endarterectomy? A randomised prospective trial [J].
Fearn, SJ ;
Parry, AD ;
Picton, AJ ;
Mortimer, AJ ;
McCollum, CN .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 1997, 13 (04) :394-397
[6]  
FREY P W, 1973, Learning and Motivation, V4, P327, DOI 10.1016/0023-9690(73)90023-4
[7]   CLINICAL RELEVANCE OF INTRAOPERATIVE EMBOLIZATION DETECTED BY TRANSCRANIAL DOPPLER ULTRASONOGRAPHY DURING CAROTID ENDARTERECTOMY - A PROSPECTIVE-STUDY OF 100 PATIENTS [J].
GAUNT, ME ;
MARTIN, PJ ;
SMITH, JL ;
RIMMER, T ;
CHERRYMAN, G ;
RATLIFF, DA ;
BELL, PRF ;
NAYLOR, AR .
BRITISH JOURNAL OF SURGERY, 1994, 81 (10) :1435-1439
[8]   NEUROPSYCHOLOGICAL IMPROVEMENT FOLLOWING ENDARTERECTOMY AS A FUNCTION OF OUTCOME MEASURE AND RECONSTRUCTED VESSEL [J].
GREIFFENSTEIN, MF ;
BRINKMAN, S ;
JACOBS, L ;
BRAUN, P .
CORTEX, 1988, 24 (02) :223-230
[9]   Is impaired cerebral vasomotor reactivity a predictive factor of stroke in asymptomatic patients? [J].
Gur, AY ;
Bova, I ;
Bornstein, NM .
STROKE, 1996, 27 (12) :2188-2190
[10]   BLOOD VELOCITY IN THE MIDDLE CEREBRAL-ARTERY AND REGIONAL CEREBRAL BLOOD-FLOW DURING CAROTID ENDARTERECTOMY [J].
HALSEY, JH ;
MCDOWELL, HA ;
GELMON, S ;
MORAWETZ, RB .
STROKE, 1989, 20 (01) :53-58