Cognitive outcomes after extracranial-intracranial bypass surgery in elderly patients diagnosed with atherosclerotic cerebral steno-occlusive artery disease
Bibliographic record
Abstract
Background The safety and clinical effectiveness of extracranial–intracranial (EC–IC) bypass surgery in elderly patients with atherosclerotic internal carotid artery and/or middle cerebral artery steno-occlusive (ACMSO) disease remain ambiguous. Here, we analyzed our experience of EC-IC bypass surgery to evaluate its clinical safety and effect on the cognitive function for elderly patients with ACMSO. Methods This retrospective study enrolled patients >60 years of age diagnosed with ACMSO who underwent EC–IC bypass surgery at the authors' center between January 2018 and January 2021. Indications for bypass surgery included symptomatic ACMSO defined by cerebral angiography and evidence of relative hypoperfusion in the territories of steno-occlusive arteries based on computed tomography perfusion (CTP) neuroimaging. All patients underwent the Montreal Cognitive Assessment preoperatively and 2 years after bypass surgery. Clinical data, such as the National Institute of Health Stroke Scale and cognitive function scores, and CTP parameters were retrospectively analyzed. Results The study cohort ultimately included data from 65 patients (60–68 years of age; median age, 66 years) who underwent 82 bypass surgeries. The patency rate of bridge arteries was 100% on intraoperative fluoroscopy and 95.0% (76/80) according to cerebral angiography at the last follow-up. The perioperative stroke rate was 1.54 % and the mortality rate was 3.08% in the 2nd year of follow-up. Compared with preoperative data, the mismatch volume of CTP was reduced (P < 0.001), and the Montreal Cognitive Assessment score significantly increased (P < 0.001) 2 years after bypass surgery. Forty patients in the cognitive improvement group had a higher educational level (P = 0.020), shorter course of disease (P = 0.041), shorter mean transit time (MTT) (P < 0.001), and shorter time to peak value (P = 0.015) on CTP, as determined by single-factor analysis before bypass, compared with those in the inactive group. Based on multivariate logistic regression analysis, a shorter preoperative MTT was an independent clinical factor for cognitive improvement after bypass (odds ratio 0.452 [95% confidence interval 0.082–0.760]; P = 0.003). Conclusion EC–IC bypass surgery was safe and improved cognitive function in elderly patients diagnosed with ACMSO. Reversible cerebral perfusion function is one of the better prognoses, which needs to be confirmed in future study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".