慢性颈内动脉闭塞导致认知功能障碍的研究进展

Research progress in cognitive impairment caused by chronic internal carotid artery occlusion

摘要:

慢性颈内动脉闭塞(CICAO)是认知功能障碍的独立危险因素，可通过多种机制影响脑部结构及血流动力学情况（包括淀粉样蛋白沉积、炎症介质形成、脑灌注不足等），导致非心脑血管事件风险增加。颈动脉系统重度狭窄或闭塞部位不同所致认知功能减退的表现形式可能存在差异，控制高血压等高危因素可降低其发生风险。临床上对于CICAO患者脑血流动力学情况常用的评估手段为CT灌注成像检查(CTP)，其可能通过间接评估侧支循环及其他血流动力学指标来预测患者出现认知功能减退的风险，但准确性仍有争议。目前临床上常用药物可在一定程度上改善患者的认知功能，尚无根治药物，血管内介入治疗可能通过降低脑梗死再发及改善脑灌注而改善认知功能，但对于纳入患者的标准仍需严格评估，其安全性及有效性仍需进一步探索。该文基于该类疾病的研究现状，对其发病机制、影响因素、评估手段及治疗方案进行综述，以期为临床诊疗及后续研究提供参考。

Abstract:

Chronic internal carotid artery occlusion（CICAO） is an independent risk factor for cognitive dysfunction. CICAO can affect brain structure and cerebral hemodynamics through multiple mechanisms-amyloid protein deposition， formation of inflammatory mediators， cerebral hypoperfusion， etc. and increase the risk of non-cardio-cerebrovascular events. The manifestations of cognitive impairment vary depending on the site of severe stenos is or occlusion of the carotid system. Controlling the high-risk factors such as hypertension can reduce the risk of cognitive impairment. Computed tomography perfusion imaging is usually performed to assess cerebral hemodynamics for patients with CICAO. It may predict the risk of cognitive decline for patients with CICAO through indirect assessment of collateralcirculation and other hemodynamic parameters， but its accuracy remains controversial. At present， cognitive impairment can be alleviated by the commonly used drugs to a limited extent. Interventional therapy is another approach considered to resolve cognitive decline by reducing the recurrence of cerebral infarction and improving cerebral perfusion， but its inclusion criteria require strict evaluation， and its safety and effectiveness need further exploration. Based on current research on cognitive impairment caused by CICAO， this article summarizes its pathogenesis， influencing factors， evaluation methods， and treatment strategies， in order to provide a reference for clinical management and future research. ［Citation:Journal of International Neurology and Neurosurgery, 2021, 48(3): 311-315］