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Effect of revascularization on cognitive outcomes in intracranial steno-occlusive disease: a systematic review

Bradley Kolb1, Hassan Fadel1, Gary Rajah1

  • 1Departments of1Neurosurgery and.

Neurosurgical Focus
|February 6, 2019
PubMed

Insights

Revascularization offers uncertain cognitive benefits for intracranial steno-occlusive disease. Current evidence from randomized trials and observational studies is limited, necessitating further research for definitive conclusions.

Area of Science:

  • Neurology
  • Neurosurgery
  • Vascular Medicine

Background:

  • Steno-occlusive diseases affecting cerebral vasculature are linked to cognitive decline.
  • Intracranial atherosclerosis and moyamoya disease (MMD) are key conditions studied.
  • The impact of revascularization on cognitive function in these patients requires clarification.

Purpose of the Study:

  • To systematically review existing literature on revascularization for intracranial steno-occlusive disease.
  • To assess the evidence quality regarding cognitive performance outcomes.
  • To determine the efficacy of revascularization in improving or maintaining cognitive function.

Main Methods:

  • Systematic literature search across major databases (PubMed/MEDLINE, Web of Science, KCI).
  • Inclusion of randomized controlled trials (RCTs) and observational cohort studies.
  • Extraction and analysis of cognitive outcomes pre- and post-revascularization.

Main Results:

  • Two RCTs (142 patients) showed no additional cognitive benefit of revascularization over maximal medical therapy for atherosclerotic steno-occlusion.
  • Seven observational studies (282 patients) suggested potential cognitive benefits for atherosclerotic steno-occlusion and MMD in children.
  • Certainty of evidence was low to very low due to study limitations and potential biases.

Conclusions:

  • The effectiveness of revascularization for cognitive improvement in intracranial steno-occlusive disease remains uncertain.
  • Limitations in current study designs and evidence quality hinder definitive conclusions.
  • Further high-quality randomized trials and observational studies are essential to guide clinical practice.

Keywords:
EC-IC = extracranial-intracranialEDAS = encephaloduroarteriosynangiosisICA = internal carotid arteryMCA = middle cerebral arteryMMD = moyamoya diseaseMoCA = Montreal Cognitive AssessmentRCT = randomized controlled trialWAIS-R = Wechsler Adult Intelligence Scale–RevisedWISC-R = Wechsler Intelligence Scale for Children–Revisedatherosclerosisbypassendovascularmoyamoyarevascularizationstenosisstent

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