Neurocognitive Impairment Assessment in Symptomatic Carotid Occlusion Recanalized Endovascularly: NIA SCORE

症状性颈动脉闭塞血管内再通的神经认知损伤评估：NIA SCORE

• 批准号: 10634259
• 负责人: David M. Hasan
• 金额: $ 114.78万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634259
• 关键词: Adult; Affect; Age; Alzheimer' s Disease; Amygdaloid structure; Anatomy; Angiography; Angioplasty; Area; Arteries; Atherosclerosis; Biological Markers; Blood Vessels; Blood flow; Bypass; Caliber; Carotid Arteries; Carotid Endarterectomy; Cerebrovascular Circulation; Cerebrum; Cervical; Classification; Clinical; Clinical Trials; Cognitive; Creatine; Data; Dementia; Development; Enrollment; Failure; Hippocampus (Brain); Hybrids; Impaired cognition; Incidence; Internal carotid artery structure; Intervention; Ipsilateral; Ischemic Stroke; Lesion; Limbic System; Magnetic Resonance Imaging; Measures; Medical; Meta-Analysis; Methods; Minor; N-acetylaspartate; Natural History; Neurocognitive Deficit; Neuropsychology; Outcome; Outcome Measure; Oxygen; Patients; Perfusion; Phase; Pilot Projects; Randomized; Recording of previous events; Recurrence; Resolution; Risk; Rupture; Spectrum Analysis; Stents; Stroke; Techniques; Testing; Time; Transient Ischemic Attack; Vascular Dementia; arm; artery occlusion; base; cerebral blood volume; cognitive function; cognitive testing; cohort; executive function; human data; improved; male; open label; prospective; radiological imaging; safety and feasibility; specific biomarkers; success

Project Summary: Complete occlusion of the internal carotid artery (COICA) by atherosclerotic disease causes approximately 15%–25% of ischemic strokes in the carotid artery distribution. Additionally, 40% of subjects with COICA who present with transient ischemic attacks and 70% of COICA who present with stroke have cognitive decline with significantly increased risk of vascular dementia and Alzheimer's' disease with time. Our group and others have used an alternative approach to revascularize subjects with COICAs. These studies showed the feasibility and safety of using endovascular angioplasty and stenting (EAS) and/or hybrid of both carotid enterectomy (CEA) and EAS to restore cerebral flow to the ipsilateral hemisphere of the COICA. Furthermore, our group devised a new angiographic and anatomic classification to upfront predict the success of revascularization using these techniques. This classification was tested in 2 pilot studies and the results showed robust plausibility to predict upfront the percentage of success anticipated in revascularizing these lesions using these techniques. In addition, 3 groups including ours showed that revascularization using these techniques restored cerebral blood flow to the ipsilateral hemisphere of the COICA evident of normalization of mean transient time (MTT) on CT perfusion (CTP) and significant improvement in the cognitive function. EAS and hybrid technique restore the caliber of the cervical ICA and therefore, the blood flow to all involved vessels with clear evidence of complete resolution of penumbra and normalization of MTT on CTP. This could provide an explanation for the marked improvement of cognitive function. Best medical management for this cohort maybe sufficient to reduce the risk of recurrent strokes and/or TIAs but not enough to improve executive and cognitive function and minimize the accelerated risk of vascular dementia and AD with time. This creates a clinical gap and a must need of an alternative approach to help this cohort. Therefore, we leverage our data and others to test the primary hypothesis below: Primary Hypothesis: Revascularizing symptomatic COICA using endovascular techniques (or Hybrid of carotid endarterectomy and endovascular techniques) will significantly improve cognitive outcome. To test this hypothesis we will examine these objectives: Primary Objective: To test the hypothesis that endovascular revascularization of COICA improves significantly cognitive function measured by Montreal Cognitive Assessment (MoCA) test. Secondary Objectives: To test the hypothesis that subjects with symptomatic COICAs and mild/moderate cognitive dysfunction have the following biomarkers: A) Large penumbra (≥50 ml) measured by mismatch volume of cerebral blood flow (CBF) & MTT on CTP, B) Presence of lactate and decreased N-acetylaspartate to creatine (Naa/Cr) in the watershed area (specifically centrum semiovale) on MRI-spectroscopy, and C) Decreased volumes of the hippocampus and amygdala on MRI.

项目摘要： 通过动脉粥样硬化疾病完全阻塞颈内动脉（COICA） 颈动脉分布中约有15％–25％的缺血性中风。另外，有40％的受试者 与出现短暂性缺血性攻击的Coica和中风的Coica有70％的Coica具有 随着时间的流逝，认知能力下降，血管性痴呆和阿尔茨海默氏病的风险显着增加。 我们的小组和其他人已经使用另一种方法来使对核心的受试者血运重建。这些 研究表明，使用血管内血管成形术和支架的可行性和安全性（EAS）和/或杂种 颈动脉肠切开术（CEA）和EA都可以恢复脑流向Coica的同侧半球。 此外，我们的小组设计了一种新的血管造影和解剖分类，以预测成功 使用这些技术进行血运重建。该分类在2个初步研究中进行了测试和结果 显示出强大的合理性，以预测预期在血运重建中预期的成功百分比 使用这些技术的病变。此外，包括我们的三个组表明，使用这些血运重建 技术恢复了脑血流向同侧半球的CoICA的标准证据 CT灌注（CTP）上的平均瞬时时间（MTT）和认知功能的显着改善。 EAS和混合技术恢复了宫颈ICA的口径，因此，血液流向所有人 涉及的血管清楚地证明了PENUMBRA的完全分辨率和MTT在CTP上的归一化。 这可以为明显改善认知功能提供解释。 该队列的最佳医疗管理可能足以降低复发性中风和/或 tias，但不足以改善执行和认知功能，并最大程度地降低血管的加速风险 痴呆和广告随着时间的流逝。这会产生临床差距，并且需要采用另一种方法来帮助这一点 队列。因此，我们利用我们的数据和其他数据来检验以下主要假设： 主要假设：使用血管内技术（或杂种 颈动脉内膜切除术和血管内技术的掌握将显着改善认知结果。 为了检验这一假设，我们将研究这些目标： 主要目的：检验以下假设：COICA改善的血管内血运重建 通过蒙特利尔认知评估（MOCA）检验测量的认知功能显着。 次要目标：检验有症状核心和温和/中等受试者的假设 认知功能障碍具有以下生物标志物：a）通过不匹配测量的大半月（≥50mL） CTP上的脑血流量（CBF）和MTT的体积 在MRI光谱法上创建（NAA/CR）在流域区域（特别是Centrum半离），C） MRI上海马和杏仁核的体积减少。