A Clinical Study on the Improvement of Cognitive Function in Symptomatic Non-Acute Internal Carotid Artery Occlusion Patients with Hasan Type A and B

Summary

This study aimed to compare vascular reperfusion with conservative treatment in patients with Hasan type A/B symptomatic NA-ICAO.

Abstract

Symptomatic non-acute internal carotid artery occlusion (NA-ICAO), particularly Hasan type A/B, is characterized by persistent cerebral hypoperfusion that may lead to neurological and cognitive impairment. Endovascular recanalization therapy (EVT) aims to restore cerebral blood flow and improve functional outcomes in patients with these conditions. A total of 66 patients with symptomatic NA-ICAO admitted between June 2022 and October 2023 were randomly assigned to an EVT group (n = 32) or a conservative medical therapy group (n = 34). Neurological and cognitive functions were evaluated before treatment and at 3 and 12 months after treatment using standardized scales, including the modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). Recanalization was successfully achieved in all 32 patients, with 9 cases reaching TICI grade 2b and 23 cases reaching TICI grade 3. Among 32 patients undergoing EVT, 12 (37.5%) experienced perioperative adverse events, including 2 (6.25%) serious events. At 3 months, the mRS score was significantly lower in the EVT group than in controls. At 12 months, the EVT group showed significantly greater improvements in MMSE, mRS, and MoCA scores, with the largest effect size observed for MoCA (Cohen's d = 0.82). Domain-specific analysis revealed significant improvement in language ability. EVT may offer potential clinical benefits for selected patients with chronic carotid occlusion; however, larger multicenter studies are warranted to confirm its long-term efficacy and safety.

Introduction

Ischemic stroke remains one of the leading causes of mortality and long-term disability worldwide, and internal carotid artery occlusion (ICAO) is a major etiological factor contributing to its occurrence¹. When the occlusion of the internal carotid artery persists for more than 24 h, it is defined as non-acute internal carotid artery occlusion (NA-ICAO)². The clinical manifestations of NA-ICAO largely depend on the compensatory capacity of the intracranial collateral circulation³. Patients with sufficient collaterals are often asymptomatic or present only mild symptoms, with a relatively low risk....

Protocol

Eligible patients were recruited at the Department of Neurological Critical Care, Weifang Traditional Chinese Medicine Hospital. All potential participants were consecutively screened using predefined inclusion and exclusion criteria by two independent neurologists. Baseline demographic and clinical information was collected from the hospital electronic medical record system using a standardized data extraction form. Formal approval for the study protocol was obtained from the Medical Research Ethics Committee of Weifang Traditional Chinese Medicine Hospital (Approval No. 2024YX091) prior to initiation of the study. All study procedures were conducted in accordance wi....

Results

Participant flow

A total of 66 symptomatic NA-ICAO patients were assessed, randomized, allocated to the EVT group (n = 32) or conservative medical therapy group (n = 34), all received the assigned treatment, and all completed the 12-month follow-up. The detailed participant flow is presented in Figure 1.

General da.......

Discussion

This study demonstrates that EVT for symptomatic NA-ICAO, particularly Hasan Type A/B lesions, can be performed safely and reproducibly when guided by a well-defined, stepwise protocol. The technical success rate of 100% and achievement of TICI 2b-3 reperfusion in all treated patients underscore the feasibility of the procedure in anatomically favorable cases. The absence of loss to follow-up additionally strengthens the reliability of the longitudinal observations. Collectively, these findings support the procedural rob.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
3.0-Tesla MRI Scanner	GE Healthcare	Discovery MR750w	Preoperative MRA and MRP imaging
Apollo Intracranial Artery Stent System	MicroPort	3.0 mm × 13 mm	Balloon-expandable intracranial stent
Arterial Sheath	Terumo	8F	Femoral artery access sheath
Aspirin Enteric-Coated Tablets	Bayer	100 mg/day	Antiplatelet therapy
Atorvastatin Calcium Tablets	Pfizer	20 mg/day	Lipid-lowering therapy
Clopidogrel Bisulfate Tablets	Sanofi	75 mg/day	Antiplatelet therapy
CT/CTA Scanner	Siemens Healthcare	SOMATOM Definition AS 128-slice	Preoperative CTA and angiography
Disposable Embolic Protection Umbrella	Taijie Weiye Medical	5.0 mm / 6.0 mm	Distal embolic protection during intervention
Drug-Coated Coronary Balloon Dilation Catheter	Medtronic	4.0 mm × 30 mm	Post-dilation to reduce elastic recoil
Hybrid DSA Operating System	(Hospital facility)	Not specified	Real-time fluoroscopic guidance for endovascular procedure
IBM SPSS Statistics	IBM Corp.	Version 26.0	Data processing and statistical analysis
Iodixanol Injection	GE Healthcare	320 mg I/mL, 80–100 mL	Angiographic contrast for DSA
Microguidewire	Asahi Intecc	0.014 inch	Navigation through occluded segment
Neuro RX Intracranial Balloon Dilation Catheter	Medtronic	2.00 mm × 15 mm	Pre-dilation of occluded ICA segment
Neuroform EZ Stent System	Stryker	4.0 mm × 20 mm	Self-expanding intracranial stent
Propofol Injection	AstraZeneca	1% (10 mg/mL)	Induction and maintenance of general anesthesia
Protege RX Tapered Carotid Stent System	Covidien	8–6 mm × 40 mm	Self-expanding carotid stent
Spider FX Embolic Protection Device	Medtronic	5.0 mm / 6.0 mm	Distal embolic protection during intervention