Abstract
Background
The direct impact of external carotid–internal carotid (EC-IC) bypass surgery on cognition
of patients with severe steno-occlusive disease of internal carotid (ICA) or middle
cerebral artery (MCA) is unknown. In this pilot study, we evaluated changes in cerebral
hemodynamic and cognition in these patients.
Methods
Patients with severe steno-occlusive disease and impaired cerebral vasodilatory reserve
(CVR) with transcranial Doppler (TCD) breath holding index (BHI) and acetazolamide-challenged
HMPAO-Single Photon Emission Tomographic (SPECT) imaging were offered EC-IC bypass
surgery. CVR and cognitive performance using a formal neuropsychological battery were
evaluated before and 3–6 months after surgery.
Results
Nine patients and 9 matched controls were recruited. Significant CVR improvement from
TCD-BHI [median 0 (Inter-quartile range IQR 0.45) to 1.10 (IQR 0.73), p<0.001] and SPECT (p<0.001) was observed in surgery patients. EC-IC bypass patients had significant improvement
in verbal memory (p=0.037) and executive function (p=0.043) and a trend of improvement in visual memory (p=0.052) compared to controls.
Conclusion
EC-IC bypass surgery in carefully selected patients could improve cerebral hemodynamics
and verbal memory and executive function.
Keywords
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Article info
Publication history
Published online: July 30, 2012
Accepted:
July 12,
2012
Received in revised form:
May 20,
2012
Received:
February 8,
2012
Identification
Copyright
© 2012 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
