1
|
Tang Y, Yang Y, Feng J, Geng Y, Wang Y, Wang R, Zhang D, Zhao J. Hybrid surgery can improve neurocognitive function in patients with internal carotid artery occlusion. Sci Rep 2023; 13:22793. [PMID: 38129543 PMCID: PMC10739823 DOI: 10.1038/s41598-023-50270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
Internal carotid artery occlusion (ICAO) is a relatively uncommon but important cause of transient ischaemic attack and cerebral infarction. Hybrid surgery (HS) improves cerebral perfusion, but its impact on neurocognitive function has been controversial. Patients with symptomatic chronic ICAO treated by hybrid surgery or medical treatment from 2016 to 2019 were included. We recorded and analysed the clinical characteristics, angiographic data, outcomes and cognitive status. Functional assessments, including the National Institutes of Health Stroke Scale (NIHSS), the Barthel Index, and a battery of neuropsychological tests, including the Mini-Mental State Examination (MMSE), Alzheimer Disease Assessment Scale-Cognitive Subtest (ADAS-cog), verbal fluency, and Colour Trail test Parts 1 and 2, were administered. Significant improvements in the ADAS (before, 7.5 ± 6.2 versus after, 5.2 ± 5.7; P = 0.022), MMSE (before, 25.5 ± 2.8 versus after, 28.1 ± 2.3; P = 0.013), and Colour Trail test Part 1 (before, 118.3 ± 26.5 versus after, 96.2 ± 23.1; P = 0.016) were observed six months after HS. Moreover, the abovementioned postprocedure scales were ameliorated in the HS group. This study found that in patients with multiple symptomatic ICAO and objective ipsilateral ischaemia, successful HS leads to improvement in the scores of three cognitive tests.
Collapse
Affiliation(s)
- Yudi Tang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yunna Yang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Junqiang Feng
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yibo Geng
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Hospital, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
2
|
Shen ZD, Qu Y, Zhang P, Wang G, Wang Y, Yang Y, Xu B, Guo ZN. Dynamic Cerebral Autoregulation After Carotid Endarterectomy. J Endovasc Ther 2023:15266028231213608. [PMID: 38014769 DOI: 10.1177/15266028231213608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Studies have shown that dynamic cerebral autoregulation (dCA) is impaired in patients with severe internal carotid artery (ICA) stenosis and that carotid endarterectomy (CEA) may improve dCA in these patients. However, the time course of dCA changes in patients after CEA remains unclear. Therefore, this study aimed to investigate the effects of CEA on the dCA in patients with carotid artery stenosis at different time points. METHODS This prospective study enrolled 44 patients (19 symptomatic stenosis patients and 25 asymptomatic stenosis patients) who underwent CEA and 44 age- and sex-matched controls. In the CEA group, the patients underwent dCA measurements at baseline, within 3 days, and 1 month after CEA. Transfer function parameters, phase difference (PD), and gain were used to quantify dCA. Changes in dCA before and after CEA were analyzed in detail. RESULTS The bilateral PD of the patients before CEA was significantly lower than that of the control group. This damage did not improve within 3 days after surgery. One month after surgery, the PD on the affected side of the patients significantly improved compared with before surgery and reached the level of the control group. The PD of affected side across time points in symptomatic and asymptomatic stenosis patients is consistent with that in all patients. CONCLUSIONS The dCA level did not improve immediately after CEA but significantly improved 1 month after surgery. This suggests that the occurrence of stroke should be considered in the acute period after CEA surgery, and its preventive effect on stroke may be effective after 1 month. CLINICAL IMPACT We found the dCA level did not improve immediately after CEA but significantly improved 1 month after surgury. This suggests that the occuttencce of stroke and surgical complications (such as cerebral hyperperfusion syndrome) associated with impaired dCA in the acute phase after CEA surgery should be of particular concern.
Collapse
Affiliation(s)
- Zi-Duo Shen
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yang Qu
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Peng Zhang
- Neuroscience Research Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Guibin Wang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - You Wang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Baofeng Xu
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Zhen-Ni Guo
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- Neuroscience Research Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
3
|
He B, Lei J, Lang X, Li Z, Cui W, Zhang Y. Ultra-fast ultrasound blood flow velocimetry for carotid artery with deep learning. Artif Intell Med 2023; 144:102664. [PMID: 37783552 DOI: 10.1016/j.artmed.2023.102664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/22/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
Accurate measurement of blood flow velocity is important for the prevention and early diagnosis of atherosclerosis. However, due to the uncertainty of parameter settings, the autocorrelation velocimetry methods based on clutter filtering are prone to incorrectly filter out the near-wall blood flow signal, resulting in poor velocimetric accuracy. In addition, the Doppler coherent compounding acts as a low-pass filter, which also leads to low values of blood flow velocity estimated by the above methods. Motivated by this status quo, here we propose a deep learning estimator that combines clutter filtering and blood flow velocimetry based on the adaptive property of one-dimensional convolutional neural network (1DCNN). The estimator is operated by first extracting the blood flow signal from the original Doppler echo signal through an affine transformation of the 1D convolution, and then converting the extracted signal into the desired blood flow velocity using a linear transformation function. The effectiveness of the proposed method is verified by simulation as well as in vivo carotid artery data. Compared with typical velocimetry methods such as high-pass filtering (HPF) and singular value decomposition (SVD), the results show that the normalized root means square error (NRMSE) obtained by 1DCNN is reduced by 54.99 % and 53.50 % for forward blood flow velocimetry, and 70.99 % and 69.50 % for reverse blood flow velocimetry, respectively. Consistently, the in vivo measurements demonstrate that the goodness-of-fit of the proposed estimator is improved by 8.72 % and 4.74 % for five subjects. Moreover, the estimation time consumed by 1DCNN is greatly reduced, which costs only 2.91 % of the time of HPF and 12.83 % of the time of SVD. In conclusion, the proposed estimator is a better alternative to the current blood flow velocimetry, and is capable of providing more accurate diagnosis information for vascular diseases in clinical applications.
Collapse
Affiliation(s)
- Bingbing He
- Department of Electronic Engineering, Information School, Yunnan University, Kunming 650091, China
| | - Jian Lei
- Department of Electronic Engineering, Information School, Yunnan University, Kunming 650091, China
| | - Xun Lang
- Department of Electronic Engineering, Information School, Yunnan University, Kunming 650091, China.
| | - Zhiyao Li
- Third Affiliated Hospital of Kunming Medical University, Kunming 650031, China
| | - Wang Cui
- Department of Electronic Engineering, Information School, Yunnan University, Kunming 650091, China
| | - Yufeng Zhang
- Department of Electronic Engineering, Information School, Yunnan University, Kunming 650091, China
| |
Collapse
|
4
|
Marshall RS, Liebeskind DS, III JH, Edwards LJ, Howard G, Meschia JF, Brott TG, Lal BK, Heck D, Lanzino G, Sangha N, Kashyap VS, Morales CD, Cotton-Samuel D, Rivera AM, Brickman AM, Lazar RM. Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis. J Stroke 2023; 25:92-100. [PMID: 36592969 PMCID: PMC9911846 DOI: 10.5853/jos.2022.02285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/17/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND PURPOSE High-grade carotid artery stenosis may alter hemodynamics in the ipsilateral hemisphere, but consequences of this effect are poorly understood. Cortical thinning is associated with cognitive impairment in dementia, head trauma, demyelination, and stroke. We hypothesized that hemodynamic impairment, as represented by a relative time-to-peak (TTP) delay on MRI in the hemisphere ipsilateral to the stenosis, would be associated with relative cortical thinning in that hemisphere. METHODS We used baseline MRI data from the NINDS-funded Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis-Hemodynamics (CREST-H) study. Dynamic contrast susceptibility MR perfusion-weighted images were post-processed with quantitative perfusion maps using deconvolution of tissue and arterial signals. The protocol derived a hemispheric TTP delay, calculated by subtraction of voxel values in the hemisphere ipsilateral minus those contralateral to the stenosis. RESULTS Among 110 consecutive patients enrolled in CREST-H to date, 45 (41%) had TTP delay of at least 0.5 seconds and 9 (8.3%) subjects had TTP delay of at least 2.0 seconds, the maximum delay measured. For every 0.25-second increase in TTP delay above 0.5 seconds, there was a 0.006-mm (6 micron) increase in cortical thickness asymmetry. Across the range of hemodynamic impairment, TTP delay independently predicted relative cortical thinning on the side of stenosis, adjusting for age, sex, hypertension, hemisphere, smoking history, low-density lipoprotein cholesterol, and preexisting infarction (P=0.032). CONCLUSIONS Our findings suggest that hemodynamic impairment from high-grade asymptomatic carotid stenosis may structurally alter the cortex supplied by the stenotic carotid artery.
Collapse
Affiliation(s)
- Randolph S. Marshall
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA,Correspondence: Randolph S. Marshall Department of Neurology, Columbia University Irving Medical Center, 710 W 168th St, New York, NY 10032, USA Tel: +1-212-305-8389 Fax: +1-212-305-3741 E-mail:
| | - David S. Liebeskind
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Lloyd J. Edwards
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Brajesh K. Lal
- Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Donald Heck
- Department of Radiology, Novant Health Clinical Research, Winston-Salem, NC, USA
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Navdeep Sangha
- Department of Neurology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Vikram S. Kashyap
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Clarissa D. Morales
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Dejania Cotton-Samuel
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Andres M. Rivera
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Adam M. Brickman
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Ronald M. Lazar
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
5
|
Gao HL, Han BS, Zhang K, Wang ZL, Gao BL, Li TX, Zhu LF. Effects of carotid artery stenting on cognitive impairment in patients with severe symptomatic carotid artery stenosis. Medicine (Baltimore) 2022; 101:e30605. [PMID: 36123929 PMCID: PMC9478282 DOI: 10.1097/md.0000000000030605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The effect of carotid artery stenting and medication on improvement of cognitive function in patients with severe symptomatic carotid artery stenosis is unknown. To investigate the effect of stenting compared with medication alone for severe carotid atherosclerotic stenosis on cognitive impairment. Patients with carotid stenosis and cognitive impairment were prospectively randomly divided into 2 groups of stenting or medication alone. Cognitive function was evaluated with the Montreal cognitive assessment (MoCA), Mini-Mental State Examination, and Barthel Index of Activities of Daily Living (BI). Continuous data in normal distribution were tested with the t-test but with the Mann-Whitney U test if not in normal distribution. Categorical data were presented as frequency and percentages and tested with the Fisher exact test. A P value < .05 was regarded as statistical significant. Carotid artery stenting was successfully performed in all patients (100%) in the stenting group. Compared with before treatment, the Mini-Mental State Examination, MoCA and BI scores at 6 months in the medication alone group and at 1, 3, and 6 months in the stenting group were significantly (P < .005) improved. The stenting group had significantly (P < .05) better scores than the medication alone group at the same time. At 6-month follow-up, the visuospatial/executive functions (3.69 ± 1.42 vs 2.42 ± 1.23), attention (5.24 ± 1.52 vs 3.63 ± 1.47), and language (2.64 ± 0.71 vs 1.96 ± 0.69) were significantly (P < .05) improved in the stenting group compared with the medication alone group. Carotid artery stenting may significantly improve cognitive impairment and neurological function compared with medication alone in patients with severe carotid atherosclerotic stenosis concurrent with cognitive impairment.
Collapse
Affiliation(s)
- Hui-Li Gao
- Henan Provincial People’s Hospital, Henan University, Zhengzhou, China
| | - Bing-Sha Han
- Henan Provincial People’s Hospital, Henan University, Zhengzhou, China
| | - Kun Zhang
- Henan Provincial People’s Hospital, Henan University, Zhengzhou, China
| | - Zi-Liang Wang
- Henan Provincial People’s Hospital, Henan University, Zhengzhou, China
| | - Bu-Lang Gao
- Henan Provincial People’s Hospital, Henan University, Zhengzhou, China
| | - Tian-Xiao Li
- Henan Provincial People’s Hospital, Henan University, Zhengzhou, China
- * Correspondence: Tian-Xiao Li, MD, PhD, Department of Interventional Therapy, Henan Provincial People’s Hospital, Henan University, 7 Wei-Wu Road, Zhengzhou, Henan Province, 450003 PR China (e-mail: )
| | - Liang-Fu Zhu
- Henan Provincial People’s Hospital, Henan University, Zhengzhou, China
| |
Collapse
|
6
|
Cognitive Functions after Carotid Artery Stenting-1-Year Follow-Up Study. J Clin Med 2022; 11:jcm11113019. [PMID: 35683407 PMCID: PMC9180931 DOI: 10.3390/jcm11113019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/29/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The revascularization of carotid arteries minimizes the risk of future cerebral stroke and usually improves cognitive functions. The aim of this study was to assess changes in cognitive function and verify the hypothesis assuming an improvement of selected cognitive functions—psychomotor speed, visuospatial episodic memory, executive function and verbal fluency—in patients after carotid artery stenting during a 12-month follow-up. Methods: 47 persons subject to CAS, including 13 symptomatic persons, were examined before and 12 months after a procedure with a psychological test battery (digit symbol test—DS, Rey–Osterrieth complex figure test—ROCF, Wisconsin Card Sorting Test—WCST, letter verbal fluency—LVF). Sociodemographic data and clinical parameters were acquired from an author questionnaire. Results: The one-year follow-up, after the performed CAS procedure, demonstrated a significant improvement of psychomotor speed, visuospatial episodic memory, and executive function. No changes in the area of verbal fluency or decline in any of cognitive functions under analysis were observed. Conclusions: Carotid artery stenting improves cognitive functioning, both in the area of basic and more complex cognitive functions in persons with carotid atherosclerosis.
Collapse
|
7
|
Piegza M, Więckiewicz G, Wierzba D, Piegza J. Cognitive Functions in Patients after Carotid Artery Revascularization-A Narrative Review. Brain Sci 2021; 11:brainsci11101307. [PMID: 34679372 PMCID: PMC8533732 DOI: 10.3390/brainsci11101307] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/12/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022] Open
Abstract
Carotid revascularization may lead to improved cognitive function beyond stroke prevention. This article summarizes the conclusions from available studies on the effects of carotid reperfusion procedures on cognitive function. The papers cited used different neuropsychological tests for cognitive assessment, resulting in different methodologies and the results obtained were not always convergent. However, most studies reported an improvement in neurocognitive abilities after both vascular interventions, but a more precise assessment of the specific benefits is still awaited. Clinical determinants to predict the effects of these treatments on cognitive function are still being sought, but results are not yet satisfactory. In view of these studies, carotid stenosis seems to be an independent risk factor for cognitive deterioration, and the main mechanisms responsible are embolism and cerebral hypoperfusion. The aim of this study is to order the knowledge about the effects of carotid artery stenting (CAS) and endarterectomy (CEA) on neurocognitive functions and to verify the usefulness of using these treatments.
Collapse
Affiliation(s)
- Magdalena Piegza
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 42-612 Tarnowskie Góry, Poland;
| | - Gniewko Więckiewicz
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 42-612 Tarnowskie Góry, Poland;
- Correspondence:
| | - Dawid Wierzba
- Independent Public Heath Care Psychiatric Hospital, 44-180 Toszek, Poland;
| | - Jacek Piegza
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Zabrze, Poland;
| |
Collapse
|
8
|
Porcu M, Cocco L, Cau R, Suri JS, Mannelli L, Yang Q, Defazio G, Wintermark M, Saba L. The mid-term effects of carotid endarterectomy on cognition and regional neural activity analyzed with the amplitude of low frequency fluctuations technique. Neuroradiology 2021; 64:531-541. [PMID: 34562140 PMCID: PMC8850244 DOI: 10.1007/s00234-021-02815-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/06/2021] [Indexed: 12/27/2022]
Abstract
Purpose The study aims to evaluate the mid-term effects of carotid endarterectomy (CEA) on cognition and resting-state functional magnetic resonance imaging (rs-fMRI) using the Amplitude of Low Frequency Fluctuations (ALFF) technique. Methods In this observational study, patients eligible for CEA were prospectively included. On the same day, within 1 week of the CEA procedure performed and 12 months after the CEA procedure, all patients underwent (i) an MRI examination for rs-fMRI analysis and (ii) a cognitive evaluation using the Italian version of the Mini-Mental State Examination (MMSE) corrected for age and schooling. Pre-CEA and post-CEA MMSE scores were evaluated using paired sample t-tests, adopting a p-value < 0.05 as statistical threshold. The ALFF technique was used for analyzing the differences between pre-CEA and post-CEA rs-fMRI scans in terms of regional neural activation. This was accomplished by applying non-parametric statistics based on randomization/permutation for cluster-level inferences, adopting a cluster-mass p-value corrected for false discovery < 0.05 for cluster threshold, and a p-uncorrected < 0.01 for the voxel threshold. Results Twenty asymptomatic patients were enrolled. The mean MMSE score resulted improved following CEA procedure (p-value = 0.001). The ALFF analysis identified a single cluster of 6260 voxels of increased regional neural activity following CEA, and no cluster of reduced activity. The majority of voxels covered the right precentral gyrus, the right middle frontal gyrus, and the anterior division of the cingulate gyrus. Conclusion Mid-term cognitive improvements observed after CEA are associated to increased regional neural activity of several cerebral regions. Supplementary Information The online version contains supplementary material available at 10.1007/s00234-021-02815-7.
Collapse
Affiliation(s)
- Michele Porcu
- Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy.
| | - Luigi Cocco
- Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Riccardo Cau
- Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Jasjit S Suri
- Stroke Diagnosis and Monitoring Division, AtheroPoint™, Roseville, CA, USA
| | | | - Qi Yang
- Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Giovanni Defazio
- Department of Neurology, University of Cagliari, Cagliari, Italy
| | - Max Wintermark
- Department of Neuroradiology, Stanford University, Stanford, CA, USA
| | - Luca Saba
- Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| |
Collapse
|