Neurocognitive Improvement After Carotid Artery Stenting in Patients With Chronic Internal Carotid Artery Occlusion: A Prospective, Controlled, Single-Center Study

作者：Fan, Yi-Ling; Wan, Jie-Qing; Zhou, Zheng-Wen; Chen, Lei; Wang, Yong; Yao, Qing; Jiang, Ji-Yao^*

来源：Vascular and Endovascular Surgery, 2014, 48(4): 305-310.

DOI：10.1177/1538574414525863

• symptomatic chronic ICA occlusion
• revascularization
• National Institutes of Health Stroke Scale
• Montreal Cognitive Assessment

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.

• 出版日期2014-5
• 单位上海交通大学