Article Figures & Data
Figures
- Fig 1.
A, Procedure-related microemboli based on the diffusion-weighted images are overlaid on a standard Montreal Neurological Institute template from 12 of 25 patients in the stent-placement group, indicated by different colors. B, The increases (red-yellow) of fractional anisotropy (the white matter skeleton is shown in green) at 3 months after aggressive medical therapy alone (Med, upper row) or combined carotid artery stent placement (Med+CAS, middle row) and the between-group comparisons (lower row). The carotid stenotic side was set to the right in all subjects. The third column from the left represents the high-power views of the insets. Note significant FA increases at the posterior corpus callosum (arrowheads) and the posterior periventricular white matter ipsilateral to the CAS in the stent-placement group.
- Fig 2.
A and B, The functional connectivity correlation maps of both groups (Med indicates medical group; Med+CAS, stent placement group) before (pre) and 3 months after treatment (post). The carotid stenotic side was set to the right. Hollow circles indicate the predefined ROIs for individual networks at the right brain. Color bars represent T values. Q indicates the false discovery rate–corrected P value. The stent-placement group, not the medical group, showed within-group enhancement of Fc at the medial prefrontal cortex (MPF, T = 5.27, cluster size = 47, Q = .027) of the default mode network (DMN) and at the insular cortex (INS; T = 5.35, cluster size = 56, Q = .040) of the dorsal attention network (DAN) (arrowheads). C, The bar chart of the aforementioned cluster sizes with increased Fc is shown. FPN indicates frontoparietal network.
- Fig 3.
Scatterplots of the correlation analyses in the medical (Med) and the stent placement group (Med+CAS). A, The baseline whole-brain mean fractional anisotropy negatively correlates with dizziness alleviation (decreases in Dizziness Handicap Inventory [DHI]) in both groups. B, The focal FA increases in the posterior corpus callosum positively correlate with the improvement of immediate verbal memory only in the stent-placement group. C, The relationship is shown between the baseline presence of mild cognitive impairment/vascular cognitive impairment no dementia and the improvement of immediate verbal memory in the 2 groups. D, The baseline stenotic degree is not related to the changes of Complex Figure Test (Recall) scores.
Tables
Med Med+CAS P Value Age (yr) 68.8 ± 8.8 71.4 ± 7.8 .348 Male sex (%) 11 (73) 21 (84) .687 Education (yr) 12 (7.5–12) 10 (7–12) .602 Stenotic degree (%) 81.3 ± 12.0 81.0 ± 9.8 .928 Total occlusion (No.) (%) 3 (20) 0 (0) .543 Hypertension (No.) (%) 12 (80) 20 (80) .611 Mean BP (mm Hg) 95.1 ± 9.5 95.3 ± 10.2 .887 Diabetes mellitus (No.) (%) 7 (47) 9 (36) .268 HbA1c (%) 6.6 ± 1.2 6.4 ± 0.4 .254 Hypercholesterolemia (No.) (%) 9 (60) 17 (68) .444 LDL (mg/dL) 85.3 ± 20.1 89.1 ± 14.7 .851 Smoking (No.) (%) 5 (33) 9 (36) .542 Atrial fibrillation (No.) (%) 1 (6.6) 0 (0) .118 Double antiplatelets (No.) (%) 8 (53) 18 (72) .345 Statins (No.) (%) 8 (53) 15 (60) .488 Dizziness Handicap Inventory 14.7 ± 19.5 18.3 ± 13.8 .541 Mini-Mental State Examination 28.4 ± 1.2 28.2 ± 1.8 .641 Verbal memory tests Total immediate recall 38.3 ± 10.5 46.1 ± 7.9 .086 Delayed recall 7.3 ± 2.3 8.1 ± 2.3 .571 Attention tests Symbol Digit Modalities Test 45.5 ± 16.3 41.9 ± 20.1 .559 Executive function tests Modified Trail-Making Test A 16.4 ± 8.6 22.4 ± 15.1 .214 Modified Trail-Making Test B 43.6 ± 28.9 53.1 ± 31.1 .455 Stroop Color and Word Test 33. ± 13.4 32.9 ± 14.6 .819 Complex visuospatial perception Complex Figure Test (Copy) 16.4 ± 1.2 15.5 ± 1.8 .109 Complex Figure Test (Recall) 10.4 ± 4.5 9.7 ± 4.2 .631 MCI/VCIND (No.) (%) 6 (40%) 7 (28%) .318 Scheltens leukoaraiosis score 5.2 ± 2.7 5.4 ± 3.1 .889 Hippocampal volume (mL) 3.3 ± 0.3 3.2 ± 0.2 .533 Ipsilateral hemispheric FA 0.50 ± 0.01 0.49 ± 0.01 .471 Contralateral hemispheric FA 0.51 ± 0.01 0.50 ± 0.01 .375 Note:—Med indicates medical therapy alone; Med+CAS, medical therapy combined with carotid artery stent placement; BP, blood pressure; LDL, low-density lipoprotein; HbA1c, hemoglobin A1c test.
ΔChanges Med Med+CAS P Value Dizziness Handicap Inventory −2.7 ± 4.8 −6.7 ± 7.1a .045a Neuropsychological tests Mini-Mental State Examination −0.2 ± 1.7 0.1 ± 1.0 .525 Total immediate recall 2.2 ± 5.6 4.2 ± 5.6a .296 Delayed recall −0.3 ± 1.2 0.6 ± 1.7 .050 Symbol Digit Modalities Test 1.7 ± 5.2 2.3 ± 4.4 .710 Modified Trail-Making Test A −0.1 ± 8.1 −2.6 ± 4.5 .309 Modified Trail-Making Test B 1.7 ± 31.9 −4.9 ± 13.1 .405 Stroop Color and Word Test 1.7 ± 5.8 2.9 ± 6.4 .545 Complex Figure Test (Copy) 0.2 ± 1.4 1.1 ± 1.4a .064 Complex Figure Test (Recall) 0.1 ± 3.1 1.7 ± 3.7 .157 Scheltens leukoaraiosis score 0.1 ± 0.3 0.2 ± 0.5 .561 Ipsilateral hemispheric FA 0.002 ± 0.04 0.009 ± 0.004 .447 Contralateral hemispheric FA 0.002 ± 0.05 0.004 ± 0.005 .681 Note:—Med indicates medical therapy alone.
↵a For dizziness and imaging measures, P < .05 was defined as significant. For the 9 neuropsychological tests, P < .0056 was defined as significant with the Bonferroni correction.
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