title: Cognitive outcome after EC-IC bypass surgery in hemodynamic cerebral ischemia.
abstract: OBJECTIVE
  The purpose of this study was to evaluate cognitive functions in patients undergoing extracranial-intracranial (EC-IC) bypass surgery for cerebral ischemia.
  
  
  METHODS
  From August 2003 to January 2009, 276 patients with occluded internal carotid arteries (ICA) were screened. Forty of these met the criteria for a low-flow EC-IC bypass. These patients were identified based on evidence of exhausted vasomotor reactivity (VMR) using the Doppler CO(2) test and CT perfusion. These patients were invited to have a complete battery of neuropsychological tests preoperatively and 12 months after surgery. Complete neurocognitive testing was finished in 20 patients.
  
  
  RESULTS
  This group of 20 patients showed preoperative cognitive impairment ranging from mild to medium-severe. There were no cases of stroke ipsilateral to the operated side during the follow-up period. VMR improvement was seen in all patients within 6 months of surgery. A comparison using a paired t-test demonstrated significant improvement 12 months after surgery in the following neuropsychological tests: WAIS-R (p = 0.01), Number Collection Test (p = 0.02), Trail Making Test (p = 0.03), and Benton Visual Retention Test (p = 0.05). Repeat analysis of variance (ANOVA) suggested the following predictors associated with cognitive improvement:the presence of ophthalmic collateral flow (p = 0.04), preoperative amaurosis fugax (p = 0.02), and external watershed infarction detected by MRI (p = 0.04).
  
  
  CONCLUSIONS
  Patients with occlusion of the ICA and exhausted VMR have cognitive impairment prior to EC-IC bypass surgery. Twelve months after surgery, there is significant improvement in various areas of cognition.
authors.affiliation: Department of Neurosurgery, České Budějovice Hospital, B.Němcové 54, 370 87, České Budějovice, Czech republic. fiedler@nemcb.cz
authors.forename: Jiří
authors.initials: J
authors.lastname: Fiedler
authors.forename: Vladimír
authors.initials: V
authors.lastname: Přibáň
authors.forename: Ondřej
authors.initials: O
authors.lastname: Skoda
authors.forename: Ivo
authors.initials: I
authors.lastname: Schenk
authors.forename: Věra
authors.initials: V
authors.lastname: Schenková
authors.forename: Simona
authors.initials: S
authors.lastname: Poláková
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000503:physiopathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000175:diagnosis / Q000503:physiopathology; D002548:Cerebral Revascularization; D003072:Cognition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011594:Psychometrics; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000502:physiology; D014888:Wechsler Scales / Q000706:statistics & numerical data