A Prospective Evaluation of Systemic Biomarkers and Cognitive Function Associated with Carotid Revascularization

作者：Zuniga Mary C; Tran Thuy B; Baughman Brittanie D; Raghuraman Gayatri; Hitchner Elizabeth; Rosen Allyson; Zhou Wei^*

来源：Annals of Surgery, 2016, 264(4): 659-665.

DOI：10.1097/SLA.0000000000001853

• carotid endarterectomy
• carotid interventions
• carotid stenosis
• carotid stenting
• cognitive function
• cytokines
• inflammatory biomarkers
• outcome

Objective:To determine factors affecting cognition and identify predictors of long-term cognitive impairment following carotid revascularization procedures.Background:Cognitive impairment is common in older patients with carotid occlusive diseases.Methods:Patients undergoing carotid intervention for severe occlusive diseases were prospectively recruited. Patients received neurocognitive testing before, 1, and 6 months after carotid interventions. Plasma samples were also collected within 24hours after carotid intervention and inflammatory cytokines were analyzed. Univariate and multivariate logistic regressions were performed to identify risk factors associated with significant cognitive deterioration (>10% decline).Results:A total of 98 patients (48% symptomatic) were recruited, including 55 patients receiving carotid stenting and 43 receiving endarterectomy. Mean age was 69 (range 54-91 years). Patients had overall improvement in cognitive measures 1 month after revascularization. When compared with carotid stenting, endarterectomy patients demonstrated postoperative improvement in cognition at 1 and 6 months compared with baseline. Carotid stenting (odds ratio 6.49, P = 0.020) and age greater than 80 years (odds ratio 12.6, P = 0.023) were associated with a significant long-term cognitive impairment. Multiple inflammatory cytokines also showed significant changes after revascularization. On multivariate analysis, after controlling for procedure and age, IL-12p40 (P = 0.041) was associated with a higher risk of significant cognitive impairment at 1 month; SDF1- (P = 0.004) and tumor necrosis factor alpha (P = 0.006) were independent predictors of cognitive impairment, whereas interleukin-6 (P = 0.019) demonstrated cognitive protective effects at 6 months after revascularization.Conclusions:Carotid interventions affect cognitive function. Systemic biomarkers can be used to identify patients at risk of significant cognitive decline postprocedures that benefit from targeted cognitive training.

• 出版日期2016-10