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Extracranial-intracranial bypass for internal carotid/middle cerebral atherosclerotic steno-occlusive diseases in conjunction with carotid endarterectomy for contralateral cervical carotid stenosis: clinical results and cognitive performance

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Abstract

Clinical results as well as cognitive performances after extracranial to intracranial (EC-IC) bypass in conjunction with contralateral carotid endarterectomy (CEA) are poorly understood. Data from 14 patients who underwent unilateral EC-IC bypass for atherosclerotic internal carotid artery (ICA)/middle cerebral artery (MCA) steno-occlusive disease in conjunction with CEA for contralateral cervical carotid stenosis were retrospectively reviewed. Postoperative results were evaluated by MRI imagings. Nine patients also underwent neuropsychological examinations (NPEs), including assessment by the Wechsler Adult Intelligence Scale-Third Edition and the Wechsler Memory Scale-Revised (WMS-R) before and about 6 months after bilateral surgeries. Postoperative MRI follow-up (median, 8 months; interquartile range, 7–8 months) confirmed successful bypass in all patients, with no additional ischemic lesions on T2WI when compared with preoperative imaging. Further, MRA showed patent bypass and contralateral smooth patency at CEA portion in all patients. In the group rate analysis, all five postoperative NPE scores (Verbal IQ, Performance IQ, WMS-memory, WMS-attention, and Average scores of all those four scores) were improved relative to preoperative NPE scores. Performance IQ and Average score improvements were statistically significant. Clinical results after EC-IC bypass in conjunction with contralateral CEA were feasible. Based on the group rate analysis, we conclude that successful unilateral EC-IC bypass and contralateral carotid endarterectomy does not adversely affect postoperative cognitive function.

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Abbreviations

CBF:

Cerebral blood flow

CSDH:

Chronic subdural hematoma

DSA:

Digital subtraction angiography

DWI:

Diffusion-weighted imaging

EC-IC:

Extracranial to intracranial

ICA:

Internal carotid artery

MCA:

Middle cerebral artery

MPRAGE:

Magnetization-prepared rapid acquisition gradient echo

MRA:

Magnetic resonance angiography

NPE:

Neuropsychological examination

OA:

Occipital artery

PIQ:

Performance IQ

SPECT:

Single-photon emission computed tomography

SSEP:

Somatosensory evoked potentials

STA:

Superficial temporal artery

T2WI:

T2-weighted image

VIQ:

Verbal IQ

WAIS-III:

Wechsler Adult Intelligence Scale-Third Edition

WMS-attention:

Attention/concentration score in WMS-R

WMS-memory:

Composite memory score in WMS-R

WMS-R:

Wechsler Memory Scale-Revised

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Authors and Affiliations

  1. Department of Neurosurgery, Fuji Brain Institute and Hospital, 270-12 Sugita, Fujinomiya-shi, Shizuoka, 418-0021, Japan

    Tomohiro Inoue, Akira Tamura & Isamu Saito

  2. Health Management Center, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan

    Kazuhiro Ohwaki

  3. Department of Neurosurgery, Showa General Hospital, Tokyo, Japan

    Kazuo Tsutsumi

  4. Department of Neurosurgery, University of Tokyo, Tokyo, Japan

    Nobuhito Saito

Authors
  1. Tomohiro Inoue
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  2. Kazuhiro Ohwaki
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  3. Akira Tamura
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  4. Kazuo Tsutsumi
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  5. Isamu Saito
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  6. Nobuhito Saito
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Correspondence to Tomohiro Inoue.

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Inoue, T., Ohwaki, K., Tamura, A. et al. Extracranial-intracranial bypass for internal carotid/middle cerebral atherosclerotic steno-occlusive diseases in conjunction with carotid endarterectomy for contralateral cervical carotid stenosis: clinical results and cognitive performance. Neurosurg Rev 39, 633–641 (2016). https://doi.org/10.1007/s10143-016-0717-8

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  • DOI: https://doi.org/10.1007/s10143-016-0717-8

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