title: Extracranial-intracranial bypass for internal carotid/middle cerebral atherosclerotic steno-occlusive diseases in conjunction with carotid endarterectomy for contralateral cervical carotid stenosis: clinical results and cognitive performance.
abstract: Clinical results as well as cognitive performances after extracranial to intracranial (EC-IC) bypass in conjunction with contralateral carotid endarterectomy (CEA) are poorly understood. Data from 14 patients who underwent unilateral EC-IC bypass for atherosclerotic internal carotid artery (ICA)/middle cerebral artery (MCA) steno-occlusive disease in conjunction with CEA for contralateral cervical carotid stenosis were retrospectively reviewed. Postoperative results were evaluated by MRI imagings. Nine patients also underwent neuropsychological examinations (NPEs), including assessment by the Wechsler Adult Intelligence Scale-Third Edition and the Wechsler Memory Scale-Revised (WMS-R) before and about 6 months after bilateral surgeries. Postoperative MRI follow-up (median, 8 months; interquartile range, 7-8 months) confirmed successful bypass in all patients, with no additional ischemic lesions on T2WI when compared with preoperative imaging. Further, MRA showed patent bypass and contralateral smooth patency at CEA portion in all patients. In the group rate analysis, all five postoperative NPE scores (Verbal IQ, Performance IQ, WMS-memory, WMS-attention, and Average scores of all those four scores) were improved relative to preoperative NPE scores. Performance IQ and Average score improvements were statistically significant. Clinical results after EC-IC bypass in conjunction with contralateral CEA were feasible. Based on the group rate analysis, we conclude that successful unilateral EC-IC bypass and contralateral carotid endarterectomy does not adversely affect postoperative cognitive function.
authors.affiliation: Department of Neurosurgery, Fuji Brain Institute and Hospital, 270-12 Sugita, Fujinomiya-shi, Shizuoka, 418-0021, Japan. t.inoue-fujinsu@beige.plala.or.jp.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Health Management Center, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ohwaki
authors.affiliation: Department of Neurosurgery, Fuji Brain Institute and Hospital, 270-12 Sugita, Fujinomiya-shi, Shizuoka, 418-0021, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Tamura
authors.affiliation: Department of Neurosurgery, Showa General Hospital, Tokyo, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsutsumi
authors.affiliation: Department of Neurosurgery, Fuji Brain Institute and Hospital, 270-12 Sugita, Fujinomiya-shi, Shizuoka, 418-0021, Japan.
authors.forename: Isamu
authors.initials: I
authors.lastname: Saito
authors.affiliation: Department of Neurosurgery, University of Tokyo, Tokyo, Japan.
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Saito
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology; D003071:Cognition / Q000502:physiology*; D016894:Endarterectomy, Carotid / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies
keywords: Carotid endarterectomy; Cognitive function; Extracranial-intracranial bypass; Neuropsychological examination