| Background:With the increasingly apparent trend of aging population,the incidence of vascular cognitive impairment(VCI)is gradually increasing.Once the patients with VCI develop to the dementia,their mental and psychological changes will be irreversible,which will bring huge economic burden to the society and their families.As the early stage of VCI,Vascular cognitive impairment no dementia(VCIND)retains certain reversibility.Therefore,strengthening the intervention of VCIND can delay or even reverse the progress of cognitive impairment.One of the important causes of VCI is chronic cerebral ischemia and hypoxia caused by insufficient cerebral perfusion.At present,enhanced external counterpulsation(EECP)is widely used in ischemic cardiovascular and cerebrovascular diseases.Additionally,some studies have shown that EECP can increase the cerebral blood flow in patients with ischemic stroke.However,in reviewing the literature,no data was found on the effects of EECP on intracranial and carotid arteries hemodynamics in patients with VCIND.Aims:This study set out with the aim of investigating the effect of EECP on intracranial and carotid arteries hemodynamics in patients with VCIND,in order to provide a new idea for the mechanism of EECP in the treatment of VCIND.Methods:Seventy patients with VCIND who were treated in our hospital,were randomized to either a control group(n=35)or EECP group(n=35).And their baseline data such as gender and age were recorded.All patients were treated sequentially with drugs for the risk factors related to VCIND,and the patients in the EECP group received EECP therapy additionally,which is once a day for 60 minutes each time for a total of 35 times.Before and after treatment,the hemodynamics parameters of intracranial and carotid arteries were recorded and calculated,which include peak velocity of the systolic wave(PSV)、end diastolic velocity(EDV)、Time average peak velocity(TAmax)、mean velocity(Vm)、pulsatility index(PI)、resistance index(RI)、blood flow volume(VF)、maximum shear rate(SRmax)、minimum shear rate(SRmin).And compared the difference of the above indicators before and after treatment.Results:During the process of this study,in the EECP group,there’re 2 cases absent,0 case excluded and 0 case discontinued.In the control group,1 case was absent,1 case was excluded and 0 case was discontinued.Finally,66 patients were actually completed and divided into 33 patients in the EECP group and 33 patients in the control group.No statistically significant differences were observed in gender,age,BMI,education level,the risk factors in VCIND,smoking history,alcohol abuse history,C-reactive protein,HbA1C,fasting blood glucose,liver enzyme,serum creatinine,blood lipids,previous medication between the EECP and control groups at study entry(P>0.05).After EECP therapy,not only the PSV,EDV,TAmax,SRmax,SRmin,VF of carotid arteries(include common carotid artery,internal carotid artery and vertebral artery)and cerebral blood flow volume increased,but also the PSV,EDV and Vm of intracranial arteries(include anterior cerebral artery,middle cerebral artery and posterior cerebral artery)increased,while PI and RI of intracranial and carotid arteries decreased(P<0.05).However,there were no changes in the PSV,EDV,TAmax,SRmax,SRmin,VF,PI,RI of intracranial and carotid arteries and cerebral blood flow volume(P>0.05).Conclusion:EECP can accelerate the blood flow velocity of intracranial and carotid arteries,increase the shear stress and cerebral blood flow volume,and improve the resistance of arterial wall,which will further improve the cerebral hypoperfusion in patients with VCIND.EECP may be an effective treatment for patients with VCIND. |
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