Patients with severe dementia and an education level below elementary school were also excluded from the study (3 patients).ĬTP scans were obtained within 24 hours preoperatively and within 48 hours postoperatively. 10, 15 National Institutes of Health Stroke Scale (NIHSS) scores were registered preoperatively. Patients with a preoperative MoCA score > 26 (normal cognitive function) were excluded (20 patients). 10, 11, 15 In addition, it assesses executive functions, which are not measured well by the Mini-Mental State Examination. It is a reliable and valid screening test for Alzheimer’s disease and related dementias. The MoCA was chosen for its brevity and simplicity combined with its good sensitivity to cognitive dysfunction. Testing was repeated at the 3-month follow-up clinic visit. ![]() Preoperative testing for the MoCA was performed within 1 month prior to the procedure (> 7 days prior to the procedure but not more than 30 days). We aimed to assess the safety, success, and neurocognitive outcomes of the recanalization of COICA using endovascular techniques (ETs) or hybrid treatment (ET plus CEA) and to identify radiological markers that could predict success. To date, a comprehensive review of the existing literature on endovascular treatment of COICA has not been performed. Perioperative complications can include distal embolization and stroke, vessel perforation, pseudoaneurysm formation, vessel dissection, fistula formation, and hyperperfusion syndrome. 14, 17 However, the risks associated with these endovascular approaches are significant. 14, 17, 21, 24, 26, 35 Despite the technical difficulty involved, these endovascular interventions in patients with symptomatic COICA have led to improvements in neurological and cognitive function. 16, 20 Recent efforts have been focused on the utilization of angioplasty and stenting to recanalize the occluded ICA. Carotid endarterectomy (CEA) and superficial temporal artery–middle cerebral artery (STA-MCA) bypass in symptomatic patients with COICA have demonstrated minimal to no benefit. 12, 30 These factors emphasize the importance of identifying the candidates who will have better functional outcomes with surgical intervention than with medical management alone as well as the most appropriate surgical approach.Įffective treatment for medically refractory COICA is challenging. 21, 27, 28 In addition, patients with COICA have been shown to suffer cognitive impairment, 1, 8 and even mild cognitive impairment significantly reduces the quality of life of such patients. ![]() T he annual risk of stroke from a chronically occluded internal carotid artery (COICA) reaches around 5%–7% despite current optimized medical management.
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