Data_Sheet_1_Cognitive Sequelae of Silent Ischemic Lesions Following Carotid Artery Stenting: Possible Role of Age-Related Moderation.docx

Background: The occurrence of ischemic lesions is common in patients receiving carotid artery stenting (CAS), and most of them are clinically silent. However, few studies have directly addressed the cognitive sequelae of these procedure-related silent ischemic lesions (SILs).
Objective: In this study, we attempted to investigate the effects of SILs on cognition using a comprehensive battery of neuropsychological tests.
Method: Eighty-five patients with unilateral carotid stenosis and 25 age-matched healthy volunteers participated in this study. Brain MRI was performed within 1 week before and 1 week after CAS to monitor the occurrence of post-CAS SILs. A comprehensive battery tapping reading ability, verbal and non-verbal memory, visuospatial function, manual dexterity, executive function, and processing speed was administered 1 week before and 6 months after CAS. To control for practice effects on repeated cognitive testing, the reliable change index (RCI) derived from the healthy volunteers was used to determine the cognitive changes in patients with carotid stenosis.
Results: Among the 85 patients with carotid stenosis, 21 patients received medical treatment (MED group), and procedure-related SILs were noted in 17 patients (SIL+ group) but not observed in 47 patients (SIL– group) after undergoing CAS. Two-way (group × phase) ANOVA revealed that the volunteer group showed improved scores in most cognitive tests while only limited improvement was noted in the SIL– group. The MED and control groups tended to show improvement in the follow-up cognitive testing than the SIL+ group. However, most of the cognitive changes for each patient group did not exceed the upper or lower limits (z = ±1.0) of the RCI.
Conclusions: Although the occurrence of procedure-related SILs is common in patients undergoing CAS, their impacts on cognitive changes after CAS may be limited. The practice effect should be taken into consideration when interpreting cognitive changes following CAS.

背景：接受颈动脉支架置入术（carotid artery stenting, CAS）的患者中，缺血性病灶的发生较为常见，且多数病灶无临床症状。然而，鲜有研究直接探讨此类手术相关无症状缺血性病灶（silent ischemic lesions, SILs）所带来的认知后遗症。
目的：本研究旨在通过一套全面的神经心理学测试组合，探究无症状缺血性病灶对认知功能的影响。
方法：本研究共纳入85例单侧颈动脉狭窄患者与25名年龄匹配的健康志愿者。分别于颈动脉支架置入术前1周内及术后1周内对受试者进行颅脑磁共振成像检查，以监测术后无症状缺血性病灶的发生情况。分别于术前1周及术后6个月，对受试者施测一套涵盖阅读能力、言语与非言语记忆、视空间功能、手部灵活性、执行功能以及信息处理速度的全面神经心理学测试组合。为控制重复认知测试中出现的练习效应，本研究采用由健康志愿者推导得出的可靠变化指数（reliable change index, RCI），来判断颈动脉狭窄患者的认知功能变化情况。
结果：在85例颈动脉狭窄患者中，21例接受药物治疗（MED组）；17例患者在术后出现手术相关无症状缺血性病灶（SIL+组），其余47例患者未观察到此类病灶（SIL–组）。双因素（组间×测试阶段）方差分析结果显示，健康志愿者组在多数认知测试中的得分均有所提升，而SIL–组仅出现有限的得分提升。相较于SIL+组，MED组与健康对照组在随访认知测试中更倾向于出现得分提升。然而，各患者组的多数认知功能变化均未超出可靠变化指数的上下限值（z=±1.0）。
结论：尽管接受颈动脉支架置入术的患者中，手术相关无症状缺血性病灶的发生较为常见，但此类病灶对术后认知功能变化的影响可能较为有限。在解读颈动脉支架置入术后的认知功能变化时，应考虑练习效应的干扰。