Effect Of Carotid Endarterectomy On Cognitive Function By Arterial Spin Labeling Perfusion Imaging

Objective The purpose of this study is to evaluate the changes of cerebral blood flow perfusion in patients with carotid artery stenosis after Carotid endarterectomy(CEA)by using Arterial Spin Labeling(ASL),and to evaluate the cognitive function of patients before and after operation by using cognitive assessment scale.By comparing the changes between the two,the correlation between the changes of cognitive function and the changes of cerebral perfusion after carotid artery dissection is further discussed.Methods 28 patients with symptomatic carotid stenosis were admitted to neurosurgery from November 2018 to December 2020 in the people’s Hospital of Inner Mongolia Autonomous Region.The patients were diagnosed as unilateral severe stenosis by digital subtraction angiography(DSA)or computed tomography angiography(CTA),and the degree of stenosis was ≥ 70%.In the patients who received carotid endarterectomy after the definite diagnosis,they received conventional magnetic resonance imaging before,on the third day and three months after operation(MRI)scan and ASL perfusion examination were used to qualitatively observe and compare the ASL perfusion imaging images of patients before and after operation.Meanwhile,the cerebral blood flow(CBF)values of frontal lobe,temporal lobe,basal ganglia and hippocampus were quantitatively analyzed in patients with carotid stenosis.Cognitive function assessment: all patients were assessed by mini mental state examination(MMSE)and Montreal Cognitive Assessment(Mo CA)before,three days after operation and 3 months after operation.Finally,the changes of CBF and cognitive score were compared after the removal of internal carotid artery,and the correlation between them was determined.Results 1.ASL cerebral perfusion indicated that there were differences in CBF values in the stenosis side and healthy side before and after operation,and the cerebral perfusion in the stenosis side was significantly lower than that of the healthy side.The difference of CBF values in each area was statistically significant(frontal lobe: P < 0.001;temporal lobe: P <0.001;basal ganglia P < 0.001;hippocampus: P < 0.001);2.compare the CBF values of the stenosis side and the healthy side before and after operation The CBF value of the patients was increased 3 days after operation,3 months after operation,and the CBF value of cerebral perfusion in the frontal lobe,temporal lobe,basal ganglia and hippocampus area were increased than before operation,and the difference was statistically significant(P < 0.001).The CBF value of each region decreased after 3 days and 3 months after operation,but all of them were higher than that before operation.3.there was no statistical significance in comparing the MMSE scores before,3 days after CEA and 3 months after operation,but the delayed recall score in single item was slightly improved,and the difference was statistically significant(P < 0.001).The total score of Mo CA was improved in 3 days and 3 months after CEA operation,and the difference was statistically significant(P < 0.001).Among them,the visual space / execution ability,abstract ability and delayed recall score were improved in single test,among which the visual space / execution ability(P < 0.001),abstract ability(P =0.013),delayed memory(P = 0.004);4.To explore the recovery of cerebral perfusion after CEA operation And the application of Pearson in the change of cognitive function Correlation coefficient analysis,evaluation of the relationship between CBF value and MMSE,Mo CA change value,3 days after operation / preoperative,3 months after operation / preoperative CBF value(patient side / healthy side ratio)and MMSE,Mo CA score correlation analysis,all had good correlation coefficient,R value was greater than 0,and the correlation was statistically significant(P < 0.05).The data suggested that CBF,MMSE,Mo CA score after CEA surgery changed The more the CBF value increases,the better Mo CA score is.Conclusion(1)ASL perfusion imaging can be used to analyze the recovery of cerebral perfusion after carotid exfoliation.Three days after CEA,cerebral perfusion in frontal lobe,temporal lobe,basal ganglia and hippocampus area was recovered obviously,CBF value decreased in 3 months after operation,but all of them were higher than before operation and kept in normal range.(2)Patients with severe carotid stenosis have cognitive dysfunction.CEA can improve cognitive dysfunction,especially in visuospatial / executive ability,abstract ability and delayed recall.(3)The relationship between cerebral reperfusion and cognitive score was analyzed.It was found that the two were linear positive correlation,and the correlation coefficient was very good,considering that it was related to the recovery of cerebral blood flow after operation.