Journal article
Randomized Evaluation of Carotid Occlusion and Neurocognition (RECON) trial: Main results
Neurology, Vol.82(9), pp.744-751
2014
DOI: 10.1212/WNL.0000000000000167
PMCID: PMC3945653
PMID: 24477109
Abstract
Objective: To determine whether extracranial-intracranial (EC-IC) bypass can improve cognition over 2 years compared to best medical therapy alone in patients with symptomatic internal carotid artery (ICA) occlusion and increased oxygen extraction fraction (OEF) on PET. Methods: Patients underwent 15O PET and were randomized if OEF ratio was >1.13 on the occluded side. Using blinded baseline and 2-year cognitive assessments, age-adjusted composite z scores were generated from subtests sensitive to right/left hemisphere plus global cognitive functioning. Multiple regression predicted 2-year cognitive change. Results: Eighty-nine patients were enrolled; 41 had increased OEF and were randomized. Two died, 2 were lost to follow-up, and 2 refused 2-year testing. Of the 35 remaining, 6 had ipsilateral stroke or death, leaving 13 surgical and 16 medical patients. Controlling for age, education, and depression, there was no difference in 2-year cognitive change between the medical and surgical arms (95% confidence interval −0.5 to 0.5, p = 0.9). In post hoc analysis of 26 patients with no stroke in the follow-up period, cognitive improvement was associated with less impaired PET OEF at baseline (p = 0.045). Conclusion: Cognitive improvement following bypass surgery was not superior to medical therapy among patients with recently symptomatic carotid occlusion and increased OEF. Among those with no recurrent stroke, less hemodynamic impairment at baseline was associated with greater cognitive gain in both groups. Reversing cognitive impairment in hemodynamic failure remains an open challenge. Classification of evidence: This study provides Class II evidence that for patients with symptomatic ICA occlusion and increased OEF on PET, EC-IC bypass compared to no bypass does not improve cognitive function after 2 years.
Details
- Title: Subtitle
- Randomized Evaluation of Carotid Occlusion and Neurocognition (RECON) trial: Main results
- Creators
- Randolph S MARSHALL - Columbia University Medical Center, New York, United StatesJoanne R FESTA - St. Luke's Roosevelt Medical Center New York, New York, United StatesYing-Kuen CHEUNG - Columbia University Medical Center, New York, United StatesMarykay A PAVOL - Columbia University Medical Center, New York, United StatesColin P DERDEYN - University of Iowa, RadiologyWilliam R CLARKE - University of lowa, Iowa City, United StatesTom O VIDEEN - Washington University, St. Louis, MO, United StatesRobert L GRUBB - Washington University, St. Louis, MO, United StatesKevin SLANE - Columbia University Medical Center, New York, United StatesWilliam J POWERS - University of North Carolina at Chapel Hill, United StatesRonald M LAZAR - Columbia University Medical Center, New York, United States
- Resource Type
- Journal article
- Publication Details
- Neurology, Vol.82(9), pp.744-751
- DOI
- 10.1212/WNL.0000000000000167
- PMID
- 24477109
- PMCID
- PMC3945653
- NLM abbreviation
- Neurology
- ISSN
- 0028-3878
- eISSN
- 1526-632X
- Publisher
- Lippincott Williams & Wilkins; Hagerstown, MD
- Language
- English
- Date published
- 2014
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984031899202771
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