Journal article
Cognitive and cerebral hemodynamic effects of endovascular recanalization of chronically occluded cervical internal carotid artery: single-center study and review of the literature
Journal of neurosurgery, Vol.132(4), pp.1158-1166
04/2020
DOI: 10.3171/2019.1.JNS183337
PMID: 30925474
Abstract
OBJECTIVERevascularization of a symptomatic, medically refractory, cervical chronically occluded internal carotid artery (COICA) using endovascular techniques (ETs) has surfaced as a viable alternative to extracranial-intracranial bypass. The authors aimed to assess the safety, success, and neurocognitive outcomes of recanalization of COICA using ETs or hybrid treatment (ET plus carotid endarterectomy) and to identify candidate radiological markers that could predict success.METHODSThe authors performed a retrospective analysis of their prospectively collected institutional database and used their previously published COICA classification to assess the potential benefits of ETs or hybrid surgery to revascularize symptomatic patients with COICA. Subjects who had undergone CT perfusion (CTP) imaging and Montreal Cognitive Assessment (MoCA) testing, both pre- and postprocedure, were included. The authors then performed a review of the literature on patients with COICA to further evaluate the success and safety of these treatment alternatives.RESULTSThe single-center study revealed 28 subjects who had undergone revascularization of symptomatic COICA. Five subjects had CTP imaging and MoCA testing pre- and postrevascularization and thus were included in the study. All 5 patients had very large penumbra involving the entire hemisphere supplied by the ipsilateral COICA, which resolved postoperatively. Significant improvement in neurocognitive outcome was demonstrated by MoCA testing after treatment (preprocedure: 19.8 ± 2.4, postprocedure: 27 ± 1.6; p = 0.0038). Moreover, successful revascularization of COICA led to full restoration of cerebral hemodynamics in all cases. Review of the literature identified a total of 333 patients with COICA. Of these, 232 (70%) showed successful recanalization after ETs or hybrid surgery, with low major and minor complication rates (3.9% and 2.7%, respectively).CONCLUSIONSETs and hybrid surgery are safe and effective alternatives to revascularize patients with symptomatic COICA. CTP imaging could be used as a radiological marker to assess cerebral hemodynamics and predict the success of revascularization. Improvement in CTP parameters is associated with significant improvement in neurocognitive functions.
Details
- Title: Subtitle
- Cognitive and cerebral hemodynamic effects of endovascular recanalization of chronically occluded cervical internal carotid artery: single-center study and review of the literature
- Creators
- Mario Zanaty - Departments of 1NeurosurgerySusanna Howard - 2Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, IllinoisJorge A Roa - University of Iowa Hospitals and ClinicsCarlos M Alvarez - Departments of 1NeurosurgeryDavid K Kung - 4Department of Neurosurgery, University of Pennsylvania, Philadelphia, PennsylvaniaDavid J McCarthy - 5Departments of Neurosurgery and Radiology, University of Miami, FloridaEdgar A Samaniego - Departments of 1Neurosurgery,, 3Neurology, and, 6Radiology, University of Iowa Hospitals and Clinics, Iowa City, IowaDaichi Nakagawa - 7Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, JapanRobert M Starke - 5Departments of Neurosurgery and Radiology, University of Miami, FloridaKaustubh Limaye - 3Neurology, andSami Al Kasab - 3Neurology, andNohra Chalouhi - 8Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; andPascal Jabbour - 8Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; andJames Torner - Departments of 9EpidemiologyDaniel Tranel - 10Neurology, and, 11Psychological and Brain Sciences, University of Iowa, Iowa City, IowaDavid Hasan - Departments of 1Neurosurgery
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery, Vol.132(4), pp.1158-1166
- DOI
- 10.3171/2019.1.JNS183337
- PMID
- 30925474
- NLM abbreviation
- J Neurosurg
- ISSN
- 0022-3085
- eISSN
- 1933-0693
- Language
- English
- Date published
- 04/2020
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Epidemiology; Psychological and Brain Sciences; Iowa Neuroscience Institute; Surgery; Injury Prevention Research Center; Neurosurgery; Otolaryngology
- Record Identifier
- 9983995061602771
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