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Acta Neurochirurgica

, Volume 153, Issue 6, pp 1303–1312 | Cite as

Cognitive outcome after EC-IC bypass surgery in hemodynamic cerebral ischemia

  • Jiří FiedlerEmail author
  • Vladimír Přibáň
  • Ondřej Škoda
  • Ivo Schenk
  • Věra Schenková
  • Simona Poláková
Clinical Article

Abstract

Objective

The purpose of this study was to evaluate cognitive functions in patients undergoing extracranial-intracranial (EC-IC) bypass surgery for cerebral ischemia.

Population and methods

From August 2003 to January 2009, 276 patients with occluded internal carotid arteries (ICA) were screened. Forty of these met the criteria for a low-flow EC-IC bypass. These patients were identified based on evidence of exhausted vasomotor reactivity (VMR) using the Doppler CO2 test and CT perfusion. These patients were invited to have a complete battery of neuropsychological tests preoperatively and 12 months after surgery. Complete neurocognitive testing was finished in 20 patients.

Results

This group of 20 patients showed preoperative cognitive impairment ranging from mild to medium-severe. There were no cases of stroke ipsilateral to the operated side during the follow-up period. VMR improvement was seen in all patients within 6 months of surgery. A comparison using a paired t-test demonstrated significant improvement 12 months after surgery in the following neuropsychological tests: WAIS-R (p = 0.01), Number Collection Test (p = 0.02), Trail Making Test (p = 0.03), and Benton Visual Retention Test (p = 0.05). Repeat analysis of variance (ANOVA) suggested the following predictors associated with cognitive improvement:the presence of ophthalmic collateral flow (p = 0.04), preoperative amaurosis fugax (p = 0.02), and external watershed infarction detected by MRI (p = 0.04).

Conclusion

Patients with occlusion of the ICA and exhausted VMR have cognitive impairment prior to EC-IC bypass surgery. Twelve months after surgery, there is significant improvement in various areas of cognition.

Keywords

Carotid arteries Cerebral revascularization Cognition Brain ischemia EC-IC bypass 

Abbreviations

ANOVA

Repeat analysis of variance

ASA

Anopyrin acetylsalicylic acid

BH/HV

Breath-holding/hyperventilation

CABG

Coronary artery bypass graft

CAS

Internal carotid artery stenting

CEA

Carotid endarterectomy

VMR

Vasomotor reactivity

DSA

Digital subtraction angiography

EC-IC bypass

Extracranial-intracranial bypass

ICA

Internal carotid artery

MRI

Magnetic resonance imaging

PCA

Principle component analysis

STA

Superficial temporal artery

TCD

Transcranial Doppler

TIA

Transient ischemic attack

WAIS-R

Wechsler Adult Intelligence Scale-Revised

Notes

Acknowledgements

The authors acknowledge the cooperation of V. Šnorek for his suggestions from the viewpoint of a psychologist standing outside the trial, Prof. J. Hernesniemi and M. Lehečka for critical remarks, and V. Apok for her assistance with the English version of the text.

Conflicts of interest

None.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Jiří Fiedler
    • 1
    • 2
    Email author
  • Vladimír Přibáň
    • 1
    • 2
  • Ondřej Škoda
    • 3
    • 4
  • Ivo Schenk
    • 5
  • Věra Schenková
    • 6
  • Simona Poláková
    • 7
  1. 1.Department of NeurosurgeryČeské Budějovice HospitalČeské BudějoviceCzech republic
  2. 2.Department of NeurosurgeryMasaryk University School of Medicine and Brno University HospitalBrno Czech Republic
  3. 3.Department of NeurologyJihlava HospitalJihlavaCzech Republic
  4. 4.Department of NeurologyCharles University 3rd School of Medicine, Královské Vinohrady University HospitalPrahaCzech Republic
  5. 5.Department of NeurologyPísekCzech Republic
  6. 6.Clinical PsychologyPísekCzech Republic
  7. 7.Faculty of ScienceUniversity of South BohemiaČeské BudějoviceCzech Republic

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