Neurocognitive improvement after carotid artery stenting in patients with chronic internal carotid artery occlusion:
Yi-Ling Fan1, Jie-Qing Wan, Zheng-Wen Zhou
1Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University Medical College, Shanghai, China.
Insights
Endovascular recanalization for symptomatic internal carotid artery occlusion is safe and feasible. Stenting improved neurological and cognitive functions compared to conservative management.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Symptomatic internal carotid artery (ICA) occlusion with hemodynamic impairment poses significant risks.
- Untreated chronic ICA occlusion leads to poor outcomes.
- Endovascular approaches offer potential treatment options.
Purpose of the Study:
- To investigate the feasibility, safety, and long-term outcomes of endovascular recanalization and stenting for chronic ICA occlusion.
- To compare outcomes between endovascular recanalization and conservative management.
Main Methods:
- Prospective, single-center, controlled study involving 40 patients with symptomatic chronic ICA occlusion.
- Patients were assigned to endovascular recanalization (n=18) or conservative management (n=22).
- Primary endpoint: 100% recanalization; secondary endpoints: neurologic and cognitive function improvement.
Main Results:
- Successful recanalization achieved in 88.9% of patients, restoring TICI 2 or 3 flow.
- No procedural or new cerebral ischemic events occurred.
- Significant improvements in National Institutes of Health Stroke Scale (NIHSS) and Montreal Cognitive Assessment (MoCA) scores were observed in the endovascular group compared to conservative management.
Conclusions:
- Endovascular recanalization and stenting are feasible and safe for symptomatic chronic ICA occlusion.
- Successful carotid artery stenting improves neurological and cognitive functions.
- This approach offers a better outcome than nonrevascularization strategies.
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.
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