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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ECarotid artery disease is thought to be one of the causes of cognitive dysfunction, but treatment of the associated cerebral blood flow impairment has never been tested in a randomized controlled trial [Marshall RS et al. \u003Cem\u003ENeurology\u003C\/em\u003E 2012], according to the results of the Randomized Evaluation of Carotid Occlusion and Neurocognition trial [RECON; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00390481\u0026amp;atom=%2Fspmdc%2F13%2F1%2F24.atom\u0022\u003ENCT00390481\u003C\/a\u003E].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDementias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEpisodic \u0026amp; Paroxysmal Disorders Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDementias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEpisodic \u0026amp; Paroxysmal Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ECarotid artery disease is thought to be one of the causes of cognitive dysfunction, but treatment of the associated cerebral blood flow impairment has never been tested in a randomized controlled trial [Marshall RS et al. \u003Cem\u003ENeurology\u003C\/em\u003E 2012]. Randolph S. Marshall, MD, MS, Columbia University Medical Center, New York, New York, USA, reported the results of the Randomized Evaluation of Carotid Occlusion and Neurocognition trial [RECON; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00390481\u0026amp;atom=%2Fspmdc%2F13%2F1%2F24.atom\u0022\u003ENCT00390481\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe RECON trial randomized 41 patients with complete internal carotid artery occlusion and hemispheral transient ischemic attack (TIA) or minor stroke in the territory of the carotid occlusion within 120 days prior to enrollment and positron emission tomography (PET) oxygen extraction fraction (OEF) \u0026gt;1.13, indicating stage II hemodynamic failure. Patients had no prior diagnosis of dementia, Barthel index \u226512\/20 at the time of enrollment, and an education level \u0026gt;4 years.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EPatients were randomized to receive surgical extracranial-intracranial (EC-IC) bypass plus best medical therapy or medical therapy alone to determine if reversing chronic hypoperfusion with EC-IC bypass can improve cognitive function or prevent its decline. Patients in the surgical arm underwent PET 30 days after surgery to measure OEF ratio. There were no differences in the baseline characteristics of the surgical and medical arms.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAll patients received 14 standardized tests as part of the neurocognitive exam at baseline and after 2 years. Left hemisphere-specific, right hemisphere-specific, and global tests were included. Individual tests were Z-scored based on age- and education-matched norms. Composite Z-scores for each patient were determined based on the average Z-score for left hemisphere plus global test scores if the patient had left carotid occlusion, and right hemisphere plus global scores if the patient had right carotid occlusion.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAt baseline, there was no difference in cognitive scores between the groups, but the average neurocognitive composite Z-score across all patients was 1.2 standard deviations below the age- and education-adjusted mean (range, \u22123.7 to \u22120.3). There was a slight, but not significant, improvement in cognitive score over 2 years for both groups, but no significant difference was found between the surgical and medical arms (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12925\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12925\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12925\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EUnadjusted Cognitive Outcomes by Treatment Group\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EIn the univariate analysis of factors correlating with cognitive change, presentation with a TIA rather than a stroke (p=0.01), improvement of depression over the 2 years (p=0.02), and a better baseline PET OEF ratio (p=0.04) were associated with cognitive improvement. The first 2 variables were significant in multiple regression.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EIn the surgical group, the OEF dropped from 1.24 to 1.14. Only 3 out of 13 surgical patients had 30-day PET OEF ratios \u22641.13, and none of the 13 patients achieved an OEF ratio \u0026lt;1.067, which is considered the upper limit of normal. Thus, hemodynamic normalization was not achieved by EC-IC bypass in the RECON cohort.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EDr. Marshall concluded that there was \u201cno evidence to support superiority of EC-IC bypass surgery plus best medical therapy in preserving or improving cognition over medical therapy alone in patients with recently symptomatic carotid artery occlusion and stage II hemodynamic failure.\u201d Further investigation with medical interventions or more effective reperfusion interventions is needed.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/1\/24.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzo3a2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzo3a2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}