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Cerebrovascular Rapid Fire Abstract

Cerebrovascular

Effect of cerebral bypass on cognitive and perfusion outcomes in patients with carotid insufficiency

Sunday, May 5, 2024
4:17 PM – 4:19 PM CT
Location:  S405a
Disclosure(s):
Michael Bounajem, MD: No financial relationships to disclose
William T. Couldwell, MD, PhD: No financial relationships to disclose
Ramesh Grandhi, MD: Balt: Consultant (Ongoing); Cerenovus: Consultant (Ongoing); Medtronic Inc: Consultant (Ongoing); Rapid Medical: Consultant (Ongoing); Stryker Neurovascular: Consultant (Ongoing)
Introduction: Carotid insufficiency (CI) due to intracranial carotid atherosclerotic disease (ICAD) or Moya Moya Disease (MMD), is significant cause for stroke. CI is managed medically until recurrent stroke is encountered, at which point extracranial-intracranial (EC-IC) bypass is pursued. The delay in bypass, however, may result in long term neurocognitive decline. Some studies have demonstrated neurocognitive benefit from EC-IC bypass in this population, however these are isolated reports requiring further substantiation. We therefore present a case series analyzing cognitive and perfusion outcomes in patients with CI treated with EC-IC bypass.

Methods: Adult patients undergoing EC-IC bypass were identified from a single institution database between January 2020 and June 2023. Electronic medical record review was conducted to collect demographic factors, comorbidities, history of stroke, modified Rankin score (mRS), Montreal Cognitive Assessment (MOCA) score, and computed tomography (CT) perfusion data. Outcomes data including complications, mRS/MOCA scores at discharge/follow-up were identified.

Results: Forty-four bypass patients were, of which 10 had cognitive assessments available for comparison. Etiology of CI was ICAD in 9 cases, and MMD in one. Perfusion imaging demonstrated a Tmax mismatch in eight cases, with an average volume of 73.6 cc at risk. Average MOCA score increased from 20 preoperatively to 23 at discharge or follow up, with an increase in 8 cases, no change in one, and decrease in one. Range of mRS scores improved to 0-2 from 1-4 preoperatively. CT perfusion data demonstrated improvements in Tmax >4 seconds (176 cc decreased to 110 cc), Tmax >6 seconds (59 cc decreased to 29 cc), and mismatch (59 cc decreased to 17 cc).

Conclusion : CT perfusion data, MOCA scores, and mRS all appear to improve after EC-IC bypass, suggestive of a true neurologic benefit that may be missed when solely relying on assessment of focal neurologic deficit in patients with ICAD and MMD. Further studies are warranted and ongoing to continue to evaluate the notion of neurocognitive benefit from EC-IC bypass in carotid insufficiency.