Study of cognitive function change after carotid endarterectomy and detection methods of misery perfusion

Abstract

We examined whether concentrations of malondialdehyde-modified low-density lipoprotein (MDA-LDL), a biochemical marker of oxidative damage, in the jugular bulb during CEA correlates with development of postoperative cognitive impairment, and proved that MDA-LDL concentration in the jugular bulb during CEA correlates with development of postoperative cognitive impairment. Recently, we examined whether postoperative changes in cerebral metabolites measured using 3-tesla proton MRS were associated with changes in cognitive function after CEA, proved postoperative changes in cerebral metabolites measured using proton MRS were associated with changes in cognitive function after CEA. On the other hand, in patients with major cerebral arterial occlusive disease, a marginally adequate blood supply relative to metabolic demand (misery perfusion) in the affected hemisphere may increase the risk of cerebral infarction. Misery perfusion can be identified by demonstrating an increased oxygen extraction fraction (OEF), which is directly measured only through positron emission tomography (PET). However, the facilities performing PET are limited, and more than half of patients who underwent SPECT with acetazolamide challenge developed adverse effects after administration of the acetazolamide. We proved that SPECT methods using IMZ-SPECT and ¹²³I-IMP SPECT (rest) can detect misery perfusion simply and safely.