Endarterectomia versus angioplastia carotídea com stent : análise neurofuncional e neuropsicológica

• Autor(a) principal: Crusius, Marcelo Ughini
• Data de Publicação: 2016
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da PUC_RS
• Texto Completo: http://tede2.pucrs.br/tede2/handle/tede/7147
• topic: ESTENOSE DAS CARÓTIDAS; ACIDENTE VASCULAR CEREBRAL; ANGIOPLASTIA; NEUROCIRURGIA; NEUROPSICOLOGIA; MEDICINA; CIENCIAS DA SAUDE::MEDICINA

Background: Carotid disease has a high prevalence as a cause of ischemic stroke. The decision between the types of treatment for carotid stenosis has been the subject of discussion on what is most benefit for patients. The procedures performed to treat this disease are Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS). Basically, in the literature, these two methods are almost equivalent procedures on the benefit caused for the patients analyzed in many ways, including the efficacy of revascularization, the complications of the procedures and the prevention of stroke. However, up to date, no research presented the analysis of functional brain connectivity networks with functional resting state MRI (rs-MRI) in patients that performed a CEA or CAS. We conducted neuropsychological tests to relate them with data from neuroimaging. This research aims to contribute in a pioneering way for knowledge in this field. Aims: Evaluate which type of procedure can bring more benefit to the patients with carotid artery disease in neuropsychological and functional brain connectivity. Method: Open randomized clinical trial with partial blinding; involving 33 subjects with cervical carotid artery stenosis with treatment indication and acceptable to both methods (CEA or CAS). At this time, the randomization was employed to patients who were dichotomized with the application of neuropsychological tests and clinical neurological examination. Group 1 represented the patients who underwent CEA with regional anesthesia loco (n = 18) and Group 2 patients underwent CAS (n = 15). Before the procedure all patients underwent rs-MRI and 4 to 8 weeks after the procedure, and were submitted again to an rs-MRI and also to a carotid ECO Doppler. The new assessment with neuropsychological tests and neurological clinical examination was performed three months after the procedure. Statistical analysis was performed using Student's t-test and analysis of variance (ANOVA). The results were considered significant when p ≤ 0.05. Results: Among the neuropsychological results, the CEA group in Boston naming test scores obtained 12.13 / 15 (±3.09) before procedure versus 13.44 / 15 (±1.63) in the post op, with p = 0.03. Visual memories (mv) tests 1 and 2 after the procedure, compared between groups showed higher values for the angioplasty group, with values of p = 0.02 for mv 1 and p = 0.007 for mv 2. Neuroimaging results showed, when the rs-RMI was analyzed with Regional Homogeneity (ReHo), three clusters in the Default Mode Network (DMN) in the CAS group; demonstrating an increase in functional connectivity post procedure. With the implementation of Independent Component Analysis (ICA) at rs-MRI, found in right frontal parietal (RFP) network 4 clusters an increased in connectivity in the post procedure for Group 2. Conclusion: There was improvement with statistical difference in two networks after angioplasty and worsening functional connectivity in these same networks with no statistical difference in the endarterectomy group postoperatively. Within the endarterectomy group had improved after the procedure in the Boston Naming Test.