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Stenting Improves Thinking

Stenting the carotid artery improved blood flow to the brain, which improved cognitive function.
by Ed Susman
UPI Correspondent
Hollywood (UPI) Jan 31, 2007
A year after patients underwent controversial treatment to improve blood flow to the brain, their cognitive function continues to improve, researchers said Wednesday. "When we first did these studies, we were hoping that we would not adversely affect our patients' mental functioning," Rodney Raabe, director of radiology at Sacred Heart Medical Center in Spokane, Wash., told United Press International.

"That's why we included a battery of psychological and cognitive tests along with the procedure."

"We were really surprised when it first appeared that -- if anything -- patients had improved, and had not gotten any worse," Raabe said at the 19th International Symposium on Endovascular Therapy. "Now we see that the differences are even greater, and are highly significant."

In his study, 62 patients underwent a procedure in which tiny coils were implanted in the carotid arteries in the neck to maintain blood flow after blockages in the blood vessel were removed through angioplasty procedures.

Raabe and colleagues were hoping to avoid the often-seen phenomena of mental confusion and cognitive loss following other procedures -- notably open-heart bypass surgery -- in which tiny bits of debris created in the repair procedure float into the brain and cause silent damage that manifests as functional deficits.

"These patients we selected weren't complaining about any problems; they were asymptomatic despite having rather severe blockages in the carotid arteries," Raabe said. It is disruption due to blockages in the carotid arteries that causes the vast majority of strokes.

"We were concerned that the procedure would cause damage in patients who had no problems," he said. "Not only did we not cause any damage that can be found, in most cases the patients improved substantially."

Of the 62 patients in the pilot study, 37 have survived more than a year and have undergone repeated cognitive tests. The patients continue to show improvements on the tests, most scoring even higher than their six-month, post-op scores.

"We have all had patients who came to us after undergoing these procedures and told us they feel better, they think better and that they are functioning better," said Alex Powell, medical director of interventional radiology at Baptist Cardiac and Vascular Institute in Miami.

"I had one patient who was having difficulty because he kept falling. Falls are not really associated with carotid artery narrowing, but after we performed the stenting procedure, his falls stopped and his cognitive functioning increased," Powell told UPI. "I really believe there is something to this." Powell said a multi-center trial to test the theory that carotid artery stenting improves function is warranted.

Raabe suggested that it is possible that our definition of what is a symptomatic carotid artery blockage -- usually seen as a stroke, a transient ischemic attack or mini-stroke -- may not be a complete definition. "I think that asymptomatic patients who have been forgetful or seem confused or have trouble with memory problems may actually be showing symptoms of carotid artery narrowing," he said. "And these individuals should be treated."

Powell said, "We often treat people who have trouble walking by increasing blood supply to the legs, and we treat people with chest pain by increasing blood supply to the heart. Perhaps we can treat people with confusion and memory loss by increasing blood supply to the brain."

There are two ways to remove carotid artery blockages. One procedure involves open surgery in which an incision is made in the neck and the carotid artery and the plaque formations are mechanically removed during the procedure. The patient's wounds are then closed.

In the stenting procedure, doctors make a small incision in the groin to gain access to the arterial system. They advance a catheter under X-ray guidance through the blood vessels and reach the blockage.

Then an umbrella-like filter is deployed upstream of the blood vessel to catch any possible tiny particle caused during the rest of the procedure to prevent that debris from causing stroke in the brain.

A balloon at the tip of the catheter is inflated, crushing the plaque to the sides of the wall of the artery. The balloon is deflated and withdrawn and the same catheter is used to deploy the stent, which props open the artery. The catheter is withdrawn and the incisions are sutured.

Hospital stays and time to return to regular activities are reduced with the catheter based treatment, Raabe said.

Raabe reported preliminary results in April 2006 at the Society of Interventional Radiology in Toronto.

Source: United Press International

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