Changes on Cognitive Function after Carotid Artery Stenting in Patients with Severe Carotid Artery Stenosis: A Prospective, 3 Months Follow-up Study

BACKGROUND: Carotid artery stenting (CAS) is emerging as an alternative to carotid endarterectomy for the treatment of carotid stenosis. The effects of CAS on cognitive function have not been fully addressed. The aim of this study was to assess the effect of carotid stenting on cognitive function from baseline to 3 months in patients with severe carotid artery stenosis through the use of a detailed neuropsychological test. METHODS: We recruited 28 patients with carotid artery stenosis (> or =70%) at baseline on a consecutive basis between February, 2009 and December, 2010. Twenty-two patients out of 28 cases, who had undergone CAS and follow-up neuropsychological evaluation after 3 months, were included in our analysis. Main cognitive outcome measures were the Seoul Neuropsychological Screening Battery-Dementia version (SNSB-D), which containing detailed cognitive tasks. We evaluated the baseline clinical characteristics and changes of cognitive outcome measures using SNSB-D in our cases from baseline to 3 months follow-up period, respectively. RESULTS: After a 3 month follow-up period, patients that underwent CAS showed significant improvement in cognitive function in total SNSB-D score compared to the baseline state of 18.1 points at 3 months (p<0.05). The other cognitive outcome measures showed significant improvements (p<0.05) in the task of confrontational naming, visual memory, and the scale of clinical dementia rating sum of box. CONCLUSION: We found that there might be a positive effect of carotid artery stenting on cognitive function from baseline to 3 months in patients with severe carotid artery stenosis.

Isolated Bilateral Abducens Nerve Palsy Caused by Basilar Artery Dissecting Aneurysm

Bilateral abducens nerve palsy is mediated mainly by increased intracranial pressure, accompaniment to subarachnoid hemorrhage and others, relatively direct involvement of abducens nerve nucleus or its intracranial pathway is unusual case. A 45-year-old male patient complaining of double vision showed isolated bilateral abducens palsy. Cerebral angiography revealed a dissecting aneurysm of the basilar artery. Bilateral abduction deficit has resolved after stent assisted coil embolization. We suggest that basilar artery dissecting aneurysm should be included as a cause of bilateral abducens nerve palsy.

The Difference in Aspirin Resistance Based on an Optical Platelet Aggregometer and the PFA-100 in Patients with Acute Ischemic Stroke / 대한뇌졸중학회지

BACKGROUND: There are many causes for the failure of aspirin therapy in patients with acute ischemic stroke. Laboratory aspirin resistance (AR) might be involved in clinical aspirin non-response. The PFA-100 is a laboratory method to evaluate AR in the clinical setting. However, there has been limited data regarding concordance with optical platelet aggregometry, which is considered the gold standard for detecting AR. We retrospectively analyzed platelet function tests using the PFA-100 and an optical platelet aggregometer in 86 patients with acute ischemic stroke. METHODS: Eighty six patients were enrolled in the study and were evaluated the platelet function test by optical aggregometer and a PFA-100. We determined the variability in the prevalence of AR and the kappa value between the two tests in patients with acute ischemic stroke. RESULTS: Among 86 patients, 27 (31.4%) were detected as AR by the optical aggregometer and 31 (36.0%) by the PFA-100. There were 13 cases of AR (15.1%) in both laboratory methods. The optical platelet aggregometer results showed that female gender (P=0.03), aspirin monotherapy (P =0.05), and NIHSS at baseline (P=0.04) were related with AR in acute ischemic stroke. Multiple logistic regression analysis showed that NIHSS was independently associated with AR of the optical platelet aggregometer (OR=1.12 95%, CI: 1.00-1.25, P=0.05). CONCLUSION: The prevalence of AR was similar between the PFA-100 and the optical platelet aggregometer in patients with acute ischemic stroke. However, the concordance rate of these two tools is low.