Mario Zanaty1, Susanna Howard2, Jorge A Roa3, Carlos M Alvarez1, David K Kung4, David J McCarthy5, Edgar A Samaniego1,3,6, Daichi Nakagawa7, Robert M Starke5, Kaustubh Limaye3, Sami Al Kasab3, Nohra Chalouhi8, Pascal Jabbour8, James Torner9, Daniel Tranel10,11, David Hasan1. 1. Departments of1Neurosurgery. 2. 2Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois. 3. 3Neurology, and. 4. 4Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania. 5. 5Departments of Neurosurgery and Radiology, University of Miami, Florida. 6. 6Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. 7. 7Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan. 8. 8Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and. 9. Departments of9Epidemiology. 10. 10Neurology, and. 11. 11Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa.
Abstract
OBJECTIVE: Revascularization of a symptomatic, medically refractory, cervical chronically occluded internal carotid artery (COICA) using endovascular techniques (ETs) has surfaced as a viable alternative to extracranial-intracranial bypass. The authors aimed to assess the safety, success, and neurocognitive outcomes of recanalization of COICA using ETs or hybrid treatment (ET plus carotid endarterectomy) and to identify candidate radiological markers that could predict success. METHODS: The authors performed a retrospective analysis of their prospectively collected institutional database and used their previously published COICA classification to assess the potential benefits of ETs or hybrid surgery to revascularize symptomatic patients with COICA. Subjects who had undergone CT perfusion (CTP) imaging and Montreal Cognitive Assessment (MoCA) testing, both pre- and postprocedure, were included. The authors then performed a review of the literature on patients with COICA to further evaluate the success and safety of these treatment alternatives. RESULTS: The single-center study revealed 28 subjects who had undergone revascularization of symptomatic COICA. Five subjects had CTP imaging and MoCA testing pre- and postrevascularization and thus were included in the study. All 5 patients had very large penumbra involving the entire hemisphere supplied by the ipsilateral COICA, which resolved postoperatively. Significant improvement in neurocognitive outcome was demonstrated by MoCA testing after treatment (preprocedure: 19.8 ± 2.4, postprocedure: 27 ± 1.6; p = 0.0038). Moreover, successful revascularization of COICA led to full restoration of cerebral hemodynamics in all cases. Review of the literature identified a total of 333 patients with COICA. Of these, 232 (70%) showed successful recanalization after ETs or hybrid surgery, with low major and minor complication rates (3.9% and 2.7%, respectively). CONCLUSIONS: ETs and hybrid surgery are safe and effective alternatives to revascularize patients with symptomatic COICA. CTP imaging could be used as a radiological marker to assess cerebral hemodynamics and predict the success of revascularization. Improvement in CTP parameters is associated with significant improvement in neurocognitive functions.
OBJECTIVE: Revascularization of a symptomatic, medically refractory, cervical chronically occluded internal carotid artery (COICA) using endovascular techniques (ETs) has surfaced as a viable alternative to extracranial-intracranial bypass. The authors aimed to assess the safety, success, and neurocognitive outcomes of recanalization of COICA using ETs or hybrid treatment (ET plus carotid endarterectomy) and to identify candidate radiological markers that could predict success. METHODS: The authors performed a retrospective analysis of their prospectively collected institutional database and used their previously published COICA classification to assess the potential benefits of ETs or hybrid surgery to revascularize symptomatic patients with COICA. Subjects who had undergone CT perfusion (CTP) imaging and Montreal Cognitive Assessment (MoCA) testing, both pre- and postprocedure, were included. The authors then performed a review of the literature on patients with COICA to further evaluate the success and safety of these treatment alternatives. RESULTS: The single-center study revealed 28 subjects who had undergone revascularization of symptomatic COICA. Five subjects had CTP imaging and MoCA testing pre- and postrevascularization and thus were included in the study. All 5 patients had very large penumbra involving the entire hemisphere supplied by the ipsilateral COICA, which resolved postoperatively. Significant improvement in neurocognitive outcome was demonstrated by MoCA testing after treatment (preprocedure: 19.8 ± 2.4, postprocedure: 27 ± 1.6; p = 0.0038). Moreover, successful revascularization of COICA led to full restoration of cerebral hemodynamics in all cases. Review of the literature identified a total of 333 patients with COICA. Of these, 232 (70%) showed successful recanalization after ETs or hybrid surgery, with low major and minor complication rates (3.9% and 2.7%, respectively). CONCLUSIONS: ETs and hybrid surgery are safe and effective alternatives to revascularize patients with symptomatic COICA. CTP imaging could be used as a radiological marker to assess cerebral hemodynamics and predict the success of revascularization. Improvement in CTP parameters is associated with significant improvement in neurocognitive functions.
Entities:
Keywords:
angioplasty and stenting; chronic internal carotid artery occlusion; endovascular; hybrid surgery; neurocognitive outcome; revascularization; total occlusion of carotid artery; vascular disorders
Authors: M Tang; X Yan; J Gao; L Li; X Zhe; Xin Zhang; F Jiang; J Hu; N Ma; K Ai; Xiaoling Zhang Journal: AJNR Am J Neuroradiol Date: 2022-07-21 Impact factor: 4.966
Authors: Paweł Latacz; Tadeusz Popiela; Maciej Anielski; Mateusz Kozka; Maciej Chwała; Marian Simka Journal: Postepy Kardiol Interwencyjnej Date: 2022-04-11 Impact factor: 1.065
Authors: Jorge A Roa; Alberto Maud; Pascal Jabbour; Guilherme Dabus; Avery Pazour; Sudeepta Dandapat; Santiago Ortega-Gutierrez; Diego Paez-Granda; Vladimir Kalousek; David M Hasan; Edgar A Samaniego Journal: Front Neurol Date: 2020-05-07 Impact factor: 4.003
Authors: Bixiao Cui; Yi Shan; Tianhao Zhang; Yan Ma; Bin Yang; Hongwei Yang; Liqun Jiao; Baoci Shan; Jie Lu Journal: Ann Nucl Med Date: 2022-07-05 Impact factor: 2.258