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

Kolb, Bradley; Fadel, Hassan; Rajah, Gary; Saber, Hamidreza; Luqman, Ali; Rangel-Castilla, Leonardo

doi:10.3171/2018.11.focus18517

Cited by 10 publications

(11 citation statements)

References 46 publications

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“…Despite the apparent relationship between severe steno-occlusive disease and cognitive impairment, prospective studies of carotid revascularization have not demonstrated any impact on cognitive performance measures. 16 The currently enrolling Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial-2 is evaluating cognitive function as a secondary end point and may shed more insight on the impact of such procedures. 17 This case series highlights the importance of considering chronic hypoperfusion and large vessel stenosis in patients presenting with clinical syndromes consistent with a neurodegenerative process.…”

Section: Discussionmentioning

confidence: 99%

Acquired Hemicerebral Atrophy Secondary to Chronic Internal Carotid Steno-Occlusive Disease: A Case Series

Vitt

Hamedani

Horn

et al. 2019

The Neurohospitalist

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Cerebral atrophy is a common finding in elderly patients; however, cerebrovascular disease causing progressive focal cerebral atrophy and dysfunction is unusual. In this report, we present 3 cases of hemicerebral atrophy due to ipsilateral internal carotid artery (ICA) stenosis or occlusion mimicking neurodegenerative conditions. Patient 1 had a frontal dysexecutive syndrome potentially consistent with a diagnosis of behavioral variant frontotemporal dementia; however, neuroimaging revealed a chronically occluded left ICA and a pattern of atrophy restricted to the left middle cerebral artery territory, suggestive of a vascular etiology. Patient 2 presented with progressively worsening seizures and right-sided weakness consistent with left hemispheric dysfunction, with radiographic evidence of left hemicerebral atrophy. Angiography revealed a chronic dissection of the left ICA leading to left cerebral hypoperfusion. Patient 3 had asymmetric parkinsonism, alien limb, and cognitive impairment consistent with a diagnosis of corticobasal syndrome. His imaging, however, revealed atrophy and encephalomalacia within the anterior circulation watershed territories with chronic, severe stenosis of the left ICA suggestive of a chronic hypoperfused state. In this case series, we report 3 examples of hemicerebral atrophy secondary to chronic ipsilateral ICA vascular disease with diverse progressive clinical symptoms mimicking primary neurodegenerative conditions. This case series highlights the importance of considering chronic hypoperfusion and large-vessel severe stenosis or occlusion in patients with cognitive impairment and evidence of asymmetric brain atrophy. In addition to symptomatic treatment, the management of vascular risk factors including treatment with antiplatelet agents, statins, and revascularization procedures can be considered.

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Section: Discussionmentioning

confidence: 99%

Acquired Hemicerebral Atrophy Secondary to Chronic Internal Carotid Steno-Occlusive Disease: A Case Series

Vitt

Hamedani

Horn

et al. 2019

The Neurohospitalist

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“…Previous reports have shown that endovascular embolization is safe and efficacious for treating intracranial aneurysm with liquid embolic agents or coils in most locations in patients with MMD [ 173 , 174 ]. Moreover, some studies [ 175 , 176 ] have reported that while EVT can be applied in atherosclerotic moyamoya syndrome, it is a major challenge to perform EVT for MMD in stenosed arteries in which super-selective catheterization is technically difficult [ 177 ]. Indeed, there are plenty of attempts to treat MMD by EVT in order to improve forward blood flow of target vessels.…”

Section: Treatmentmentioning

confidence: 99%

Progression in Moyamoya Disease: Clinical Features, Neuroimaging Evaluation, and Treatment

Zhang

Xiao

Zhang

et al. 2022

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: Moyamoya disease (MMD) is a chronic cerebrovascular disease characterized by progressive stenosis of the arteries of the circle of Willis, with the formation of the collateral vascular network at the base of the brain. Its clinical manifestations are complicated. Numerous studies have attempted to clarify the clinical features of MMD, including its epidemiology, genetic characteristics, and pathophysiology. With the development of neuroimaging techniques, various neuroimaging modalities with different advantages have deepened the understanding of MMD in structural, functional, spatial, and temporal dimensions. At present, the main treatment for MMD focuses on neurological protection, cerebral blood flow reconstruction, and neurological rehabilitation, such as pharmacological treatment, surgical revascularization, and cognitive rehabilitation. In this review, we discuss recent progress in understanding the clinical features, neuroimaging evaluation, and treatment of MMD.

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“…Cerebral hypoperfusion induced by steno-occlusive diseases has been thought to be associated with cognitive decline [10][11][12]. If so, the status of cerebral hemodynamics (especially stage 2) may be estimated using cognitive function tests.…”

Section: Introductionmentioning

confidence: 99%

“…If so, the status of cerebral hemodynamics (especially stage 2) may be estimated using cognitive function tests. Some previous reports suggested that EC-IC bypass improves cognitive function in patients with steno-occlusive disease [ 11 , 12 ]. However, these previous studies have some limitations, and the effect of EC-IC bypass on cognitive function has remained controversial [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Increased cerebrovascular reactivity in selected brain regions after extracranial-intracranial bypass improves the speed and accuracy of visual cancellation in patients with severe steno-occlusive disease: a preliminary study

et al. 2022

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The effect of the change in cerebrovascular reactivity (CVR) in each brain area on cognitive function after extracranial-intracranial bypass (EC-IC bypass) was examined. Eighteen patients who underwent EC-IC bypass for severe unilateral steno-occlusive disease were included. Single-photon emission CT (SPECT) for evaluating CVR and the visual cancellation (VC) task were performed before and after surgery. The accuracy of VC was expressed by the arithmetic mean of the age-matched correct answer rate and the accurate answer rate, and the averages of the time (time score) and accuracy (accuracy score) of the four VC subtests were used. The speed of VC tended to be slower, whereas accuracy was maintained before surgery. The EC-IC bypass improved CVR mainly in the cerebral hemisphere on the surgical side. On bivariate analysis, when CVR increased post-operatively, accuracy improved on both surgical sides, but the time score was faster on the left and slower on the right surgical side. Stepwise multiple regression analysis showed that the number of the brain regions associated with the time score was 5 and that associated with the accuracy score was 4. In the hemodynamically ischemic brain, processing speed might be adjusted so that accuracy would be maintained based on the speed-accuracy trade-off mechanism that may become engaged separately in the left and right cerebral hemispheres when performing VC. When considering the treatment for hemodynamic ischemia, the relationship between CVR change and the speed-accuracy trade-off in each brain region should be considered.

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

Cited by 10 publications

References 46 publications

Acquired Hemicerebral Atrophy Secondary to Chronic Internal Carotid Steno-Occlusive Disease: A Case Series

Acquired Hemicerebral Atrophy Secondary to Chronic Internal Carotid Steno-Occlusive Disease: A Case Series

Progression in Moyamoya Disease: Clinical Features, Neuroimaging Evaluation, and Treatment

Increased cerebrovascular reactivity in selected brain regions after extracranial-intracranial bypass improves the speed and accuracy of visual cancellation in patients with severe steno-occlusive disease: a preliminary study

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