1050. Cognitive and Cerebral Hemodynamic effect of Endovascular Recanalization of COICA: Pilot Study and Meta-analysis

Authors: Mario Zanaty, MD; Susanna Howard; David Kung; David McCarthy; Edgar Samaniego; Daichi Nakagawa; Robert Starke; Limaye Kaustubh; Sami AlKasab; Nohra Chaloiuhi; Pascal Jabbour; David Hassan (Iowa City, IA)

Introduction: Revascularization of symptomatic, medically refractory, chronically occluded cervical ICA (COICA) using endovascular techniques (ET) or hybrid of carotid endarterectomy (CEA) and ET, surfaced as a viable alternative to the extracranial to intracranial bypass. To examine its potential benefits, we performed a pilot study, and then conducted the first meta-analysis of the literature to validate our findings . Methods: We used our published COICA classification to revascularize symptomatic COICA using either ET or hybrid techniques. Subjects who underwent CT perfusion (CTP) and Montreal Cognitive Assessment (MoCA) testing, pre and post procedure, were included in this pilot study. Then we performed a meta-analysis of the studies of COICA subjects undergoing recanalization via these techniques. Results: From January 2016 and June of 2018, 28 subjects underwent revascularization of symptomatic COCIA. Only 5 subjects (6 COICAs) had CTP and MoCA pre and post revascularization. All subjects had very large penumbra involving the entire hemisphere supplied by the ipsilateral COICA, which resolved postop. No permanent complications were associated with the procedure. All subjects had marked improvement in their neurocognitive outcomes (pre MoCA: 19.8±2.4, post MoCA: 27±1.6; p-0.0038). The meta-analysis included 16 studies with 333 subjects with COICA. The mean age of the patient sample was 67.2±9.3 years old. 70% had successful recanalization with a total of 3.9% and 2.4% of subjects experienced major and minor complications following the procedure, respectively. Two studies reported significant improvement of neurocognitive testing after successful recanalization. Conclusion: Our results suggests that: 1) ET or a hybrid (ET and CEA) is a relatively safe procedure to revascularize subjects with symptomatic COICA; 2) CTP could be used as a metric/biomarker to assess cerebral hemodynamics in symptomatic COICA and success of revascularization; and 3) Improvement in CTP parameters is associated with significant improvement in the neurocognitive function of these subjects