title: Neurocognitive improvement after carotid artery stenting in patients with chronic internal carotid artery occlusion: a prospective, controlled, single-center study.
abstract: Symptomatic internal carotid artery (ICA) occlusion with hemodynamic impairment remains a dismal disease when untreated. In this prospective, single-center, controlled study, we investigated the feasibility, safety, and long-term outcome of stenting by endovascular recanalization for patients with chronic ICA occlusion. Forty patients with symptomatic chronically occluded ICA were assigned to receive endovascular recanalization (group A, n = 18) or conservative management (group B, n = 22). The primary end point was 100% complete recanalization of the primary occlusion at 60 minutes, and secondary end points were improvement in neurologic function and cognitive function. Patients in the 2 groups were comparable in demographic and baseline characteristics. Successful recanalization was achieved in 88.9% (16 of 18) of patients with the restoration of Thrombolysis in Myocardial Ischemia/Thrombolysis in Cerebral Ischemia 2 or 3 flow. There was no procedural or new cerebral ischemic event. Improvement in brain perfusion was observed in 12 (12 of 18, 75%) patients on single-photon emission computed tomography. Improvement in neurologic function defined as a reduction of ≥4 points on the National Institutes of Health Stroke Scale (NIHSS) at 6 months was observed in group A (baseline, 6.83 ± 3.01 vs 6 months, 2.61 ± 1.20; P < .01) and group B (baseline, 6.05 ± 2.75 vs 6 months, 4.77 ± 1.69; P < .05). A significant difference in NIHSS scores was noted between group A and B at 1, 3, and 6 months (P < .05 or .001). Improvement in cognitive function defined as an increase of ≥8 on the Montreal Cognitive Assessment (MoCA) was observed in group A at 3 and 6 months (baseline, 14.67 ± 3.56 vs 3 months, 24.17 ± 3.55 and 6 months, 24.72 ± 2.85; P < .01). Significant improvement in MoCA was also observed in group B (P < .01). Furthermore, a significant difference in MoCA scores was noted between group A and B at 1, 3, and 6 months (P < .05 or .001). Endovascular recanalization is feasible and safe for patients with symptomatic chronic carotid artery occlusion. Successful carotid artery stenting can improve neurological function and global cognitive function than nonrevascularization.
authors.affiliation: Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University Medical College, Shanghai, China.
authors.forename: Yi-Ling
authors.initials: YL
authors.lastname: Fan
authors.forename: Jie-Qing
authors.initials: JQ
authors.lastname: Wan
authors.forename: Zheng-Wen
authors.initials: ZW
authors.lastname: Zhou
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.forename: Qing
authors.initials: Q
authors.lastname: Yao
authors.forename: Ji-Yao
authors.initials: JY
authors.lastname: Jiang
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000517:prevention & control*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002908:Chronic Disease; D003072:Cognition Disorders / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D061214:Patient Safety; D011446:Prospective Studies; D011859:Radiography; D015607:Stents; D016896:Treatment Outcome
keywords: Montreal Cognitive Assessment; National Institutes of Health Stroke Scale; revascularization; symptomatic chronic ICA occlusion