Effects of Endovascular Stent-Assisted Angioplasty on Cellular Metabolism in the Hippocampus of Elderly Patients with Symptomatic Vertebrobasilar Artery Stenosis

Overview

Journal Med Sci Monit

Specialties General Medicine
Pathology

Date 2020 May 12

PMID 32390653

Authors

Yongxing Yan

Jun Wang

Changyang Zhong

Yan Zhang

Yingnan Wei

Huili Liu

Affiliations

Soon will be listed here.

Abstract

BACKGROUND Cerebral artery stenosis is closely related to cognitive function, and angioplasty can improve the cognitive function of elderly patients with vertebrobasilar artery stenosis. The specific mechanism, however, is not clear. This study explored the effect of angioplasty on cellular metabolism in the hippocampus of elderly patients with symptomatic vertebrobasilar artery stenosis. MATERIAL AND METHODS Eighteen elderly patients with symptomatic vertebrobasilar artery stenosis who underwent endovascular stent-assisted angioplasty (ESAA) in our department were studied. The changes in cellular metabolism (NAA / Cr, CHO / Cr, NAA / CHO) in bilateral hippocampal areas were detected by MRS before and at 6 months and 12 months after the ESAA. The Montreal Cognitive Assessment Scale (MoCA), Hamilton Depression Self-assessment Scale (HAMD), and Hamilton Anxiety Self-assessment Scale (HAMA) were also used to evaluate the cognition, depression, and anxiety of patients at different time points of the study, and analyzed the correlation between the changes of cellular metabolism in the hippocampus and the scores of MoCA, HAMD, and HAMA. RESULTS The levels of NAA/Cr in left/right hippocampal areas were significantly higher at 6 and 12 months after the ESAA than before (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, respectively) (P<0.01). MoCA scores were positively correlated with the levels of NAA/Cr in the left/right hippocampal areas (P<0.05 and P<0.01, respectively). CONCLUSIONS ESAA can improve cognitive function of patients by changing the cellular metabolism of the hippocampus in elderly patients with symptomatic vertebrobasilar artery stenosis.

References

Haghighi A, Edgell R, Cruz-Flores S, Zaidat O . Vertebral artery origin stenosis and its treatment. J Stroke Cerebrovasc Dis. 2011; 20(4):369-76. DOI: 10.1016/j.jstrokecerebrovasdis.2011.05.007. View

Keage H, Churches O, Kohler M, Pomeroy D, Luppino R, Bartolo M . Cerebrovascular function in aging and dementia: a systematic review of transcranial Doppler studies. Dement Geriatr Cogn Dis Extra. 2012; 2(1):258-70. PMC: 3398823. DOI: 10.1159/000339234. View

Merwick A, Werring D . Posterior circulation ischaemic stroke. BMJ. 2014; 348:g3175. DOI: 10.1136/bmj.g3175. View

Ausman J, Diaz F, Vacca D, Sadasivan B . Superficial temporal and occipital artery bypass pedicles to superior, anterior inferior, and posterior inferior cerebellar arteries for vertebrobasilar insufficiency. J Neurosurg. 1990; 72(4):554-8. DOI: 10.3171/jns.1990.72.4.0554. View

Markus H, van der Worp H, Rothwell P . Posterior circulation ischaemic stroke and transient ischaemic attack: diagnosis, investigation, and secondary prevention. Lancet Neurol. 2013; 12(10):989-98. DOI: 10.1016/S1474-4422(13)70211-4. View

Tu J, Wang L, Wen H, Xu Y, Wang P . The association of different types of cerebral infarction with post-stroke depression and cognitive impairment. Medicine (Baltimore). 2018; 97(23):e10919. PMC: 5999486. DOI: 10.1097/MD.0000000000010919. View

Sun D, Zhang J, Fan Y, Liu X, Gao Y, Wu G . Abnormal levels of brain metabolites may mediate cognitive impairment in stroke-free patients with cerebrovascular risk factors. Age Ageing. 2014; 43(5):681-6. DOI: 10.1093/ageing/afu027. View

Blacker D, Flemming K, Wijdicks E . Risk of ischemic stroke in patients with symptomatic vertebrobasilar stenosis undergoing surgical procedures. Stroke. 2003; 34(11):2659-63. DOI: 10.1161/01.STR.0000092120.03676.D6. View

Pereira F, Ferreira E, de Oliveira R, Milani H . Time-course of neurodegeneration and memory impairment following the 4-vessel occlusion/internal carotid artery model of chronic cerebral hypoperfusion in middle-aged rats. Behav Brain Res. 2012; 229(2):340-8. DOI: 10.1016/j.bbr.2012.01.023. View

10.

Yan Y, Liang L, Yuan Y, Chen T, Shen Y, Zhong C . Influence of stent-assisted angioplasty on cognitive function and affective disorder in elderly patients with symptomatic vertebrobasilar artery stenosis. Med Sci Monit. 2014; 20:1129-36. PMC: 4095702. DOI: 10.12659/MSM.890592. View

11.

. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet. 2018; 391(10136):2236-2271. PMC: 5986687. DOI: 10.1016/S0140-6736(18)30994-2. View

12.

Barnes D, Alexopoulos G, Lopez O, Williamson J, Yaffe K . Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the Cardiovascular Health Study. Arch Gen Psychiatry. 2006; 63(3):273-9. DOI: 10.1001/archpsyc.63.3.273. View

13.

Cheng H, Lin C, Soong B, Wang P, Chang F, Wu Y . Impairments in cognitive function and brain connectivity in severe asymptomatic carotid stenosis. Stroke. 2012; 43(10):2567-73. DOI: 10.1161/STROKEAHA.111.645614. View

14.

Zhou M, Wang H, Zhu J, Chen W, Wang L, Liu S . Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 387(10015):251-72. DOI: 10.1016/S0140-6736(15)00551-6. View

15.

Lattanzi S, Carbonari L, Pagliariccio G, Bartolini M, Cagnetti C, Viticchi G . Neurocognitive functioning and cerebrovascular reactivity after carotid endarterectomy. Neurology. 2017; 90(4):e307-e315. DOI: 10.1212/WNL.0000000000004862. View

16.

Drazyk A, Markus H . Recent advances in the management of symptomatic vertebral artery stenosis. Curr Opin Neurol. 2017; 31(1):1-7. DOI: 10.1097/WCO.0000000000000515. View

17.

Demougeot C, Garnier P, Mossiat C, Bertrand N, Giroud M, Beley A . N-Acetylaspartate, a marker of both cellular dysfunction and neuronal loss: its relevance to studies of acute brain injury. J Neurochem. 2001; 77(2):408-15. DOI: 10.1046/j.1471-4159.2001.00285.x. View

18.

Wang T, Xiao F, Wu G, Fang J, Sun Z, Feng H . Impairments in Brain Perfusion, Metabolites, Functional Connectivity, and Cognition in Severe Asymptomatic Carotid Stenosis Patients: An Integrated MRI Study. Neural Plast. 2017; 2017:8738714. PMC: 5309400. DOI: 10.1155/2017/8738714. View

19.

Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L . Prevalence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480 687 Adults. Circulation. 2017; 135(8):759-771. DOI: 10.1161/CIRCULATIONAHA.116.025250. View

20.

Wu S, Wu B, Liu M, Chen Z, Wang W, Anderson C . Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol. 2019; 18(4):394-405. DOI: 10.1016/S1474-4422(18)30500-3. View