| BackgroundSymptomatic Vertebrobasilar artery stenosis is one of the important causes of posterior circula-tion ischemic(PCI).Although PCIaccounts for about 20% of all stroke,and the di-agnostic rate of PCI is low due to the non-specificity of clinical symptoms of the ver-tebral basilar artery system and the non-sensitivity of imaging,but its mortality can be as high as 40%-86%,and the good prognosis about on-ly13%-21%.Therefore,active and effective management of veterbrobasilar artery stenosis early is extremely important.At present,Endovascular stent-assistant angioplasty(ESAA)is one of the c-mmonly methods in the treatment of symptomatic vertebrobasilar artery stenosis.Bo-th short-term and long-term results are good.Stdies have found that ESAA can not only prevent recurrence of stroke,but also imp-rove cognitive function of patients.Ho-wever,previous studies mostly focused on the effect of ESAA on cognitive function of patients with carotid artery stenosis,w-hile less attention was paid to the relationsh-ip between vertebrobasilar artery stenosis and cognitive function.Our previous stud-ies found that ESAA can improv-e cognitive function in elderly patients with vertebrobasilar artery stenosis,but th-e study only used dementia scale to detect cognitive f-unction,there is a certain subjectivity,need more objective indicators.In this study,magnetic resonance spectroscopy(MRS)was used to evaluate the changes of cell metabolism in hippocampus of patients with vertebrobasilar artery stenosis before and after stenting,to ev-aluate its value more objectively.objectiveTo investigate the effects of ESAA on cellular metabolism in hippocampus,cognition,depression and anxiety in elderly patients with symptomatic vertebrobasilar artery stenosis,and to analyze the correlation between cellular metabolism in hippocampus and cognitive changes.MethodEighteen elderly patients with symptomatic vertebrobasilar artery stenosis treated by ESAA were selected in our department from January 2015 to January 2018.The changes of cellular metabolism(NAA/Cr,Cho/Cr,NAA/Cho)in bilateral hippocampus temporal lobe were detected by MRS before ESAA,6 and 12 months aft-er ESAA.Montreal cognitive assessment(MOCA),Hamilton self-rating depressi-on scale(HAMD)and Hamilton Self-Rating Anxiety Scale(HAMA)were used in the same period.There were used to assess the cognitive,depression and anxiety at different time points,to analyze the correlation between the changes of cell metabolism in hippocampal and Moca score also.ResultThe incidence of cognitive impairment,depression and anxiety in patients with vertebrobasilar artery stenosis before ESAA was 50.0%,22.2% and 55.6%,respect-ively.Moca score was significantly improved in 6 and 12 months after ESAA(27.50±1.50 Vs 27.90±1.53 Vs 25.22±2.80).The difference was significant statitically(P < 0.01).The incidence of depression and anxiety was significantly reduced after ESAA.The level of NAA/Cr in left/right hippocampus increased significantly in 6 and 12 months after ESAA(1.01±0.17/1.22±0.26 Vs 1.10±0.20 /1.05±0.26 Vs 0.82±0.10/0.84±0.11).The difference was also significant statistically(P < 0.01),and the Moca score was positively correlated with the level of N AA/Cr in left/right hippocampus(P < 0.05,P < 0.01).conclusion1.Symptomatic vertebrobasilar artery stenosis in elderly patients have a higher incidence of mild cognitive impairment,depression and anxiety.ESAA can improimprove cell metabolism in hippocampus of temporal lobe,cognitive and emotional impairm-ent in elderly patients with symptomatic vertebrobasilarartery stenosi-s.2.There was a positive correlation between NAA/Cr level and Moca score in t-he hippocampus of the temporal lobe in elderly patients with symptomatic veterbralbasilar artery stenosis.Cognitive function was improved after stenting.The mechanism may be related to the improvement of cellular metabolism in the hippocampus. |
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