Effect of Carotid Artery Morphological Variations on Cognitive Function

Background. Carotid artery morphological variations (CAMV) are common variations on medical imaging; the effects of CAMV on cognition were still unknown. This study is aimed at investigating whether carotid artery morphological variations (CAMV) cause cognitive impairment. Methods. Hospitalized patients from March 2017 to October 2017 who underwent digital subtract angiography (DSA) were divided into non-CAMV group, T-type group, K-type group, and C-type group according to their carotid artery morphology. Cognitive function in each group was evaluated with the Mini-Mental State Scale (MMSE), the Montreal Cognitive Assessment (MoCA), the Verbal Fluency Test (VFT), and the Digital Span Test (DST). Results. A total of 96 patients were included in the study (32 in non-CAMV group, 34 in T-type group, 30 in K-type group, and none in C-group). The positive rate of MMSE in the non-CAMV group, the T-type group, and the K-type group was 15.6%, 14.7%, and 20.0%, respectively, with no statistical difference in the three groups (p=0.836). The positive rate of MoCA in the K-type group was significantly higher than that in the non-CAMV and the T-type groups (p<0.001), but there was no significant difference between the non-CAMV group and the T-type group (p=0.826). The VFT, DST forward score, and backward score in the K-type group were significantly lower than those in the non-CAMV and the T-type groups (p<0.001). Conclusions. K-type CAMV may cause cognitive impairment, and MoCA is superior to MMSE in identifying mild cognitive impairment caused by CAMV.

Safety and Validity of Mechanical Thrombectomy and Thrombolysis on Severe Cerebral Venous Sinus Thrombosis

BACKGROUND: Although the majority of patients with cerebral venous sinus thrombosis (CVST) obtain an optimistic clinical outcome after heparin or warfarin treatment, there remains a subgroup of patients who do not respond to conventional anticoagulation treatment. These patients, especially younger people, as documented by hospital-based studies, have a high morbidity and mortality rate. OBJECTIVE: To verify the safety and efficacy of a dual mechanical thrombectomy with thrombolysis treatment modality option in patients with severe CVST. METHODS: Fifty-two patients diagnosed with CVST were enrolled and treated with mechanical thrombectomy combined with thrombolysis. Patients underwent urokinase 100 to 1500 × 103 IU intravenous sinus injection via a jugular catheter after confirming diagnoses of CVST by using either magnetic resonance imaging/magnetic resonance venography or digital subtract angiography. Information obtained on the patients included recanalization status of venous sinuses as evaluated by magnetic resonance venography or digital subtract angiography at admission, during operation, and at 3- and 6-month follow-up after treatment. RESULTS: The percentage of patients that showed complete and partial recanalization were 87% and 6%, respectively, after mechanical thrombectomy combined with thrombolysis treatment; 8% of the patients showed no recanalization. The modified Rankin Scale scores were 1.0 ± 0.9, 0.85 ± 0.63, and 0.37 ± 0.53 for discharge, and 3- and 6-month follow-up, respectively. A total of 6 patients died despite receiving aggressive treatment. No cases of relapse occurred after 3 to 6 months of follow-up. CONCLUSION: Thrombectomy combined with thrombolysis is a safe and valid treatment modality to use in severe CVST cases or in intractable patients that have shown no adequate response to antithrombotic drugs.