Trial reportNeurology2014
Randomized Evaluation of Carotid Occlusion and Neurocognition (RECON) trial: main results.
Trial report in Neurology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 76 citations in OpenAlex.
- Recurrent Hemispheric Stroke Syndromes in Symptomatic Atherosclerotic Internal Carotid Artery Occlusions: The Carotid Occlusion Surgery Study Randomized Trial.Neurosurgery · 2020Trial
- The stronger one-sided relative hypoperfusion, the more pronounced ipsilateral spatial attentional bias in patients with asymptomatic carotid stenosis.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2020Trial
- Is There Benefit from Stenting on Cognitive Function in Intracranial Atherosclerosis?Cerebrovascular diseases (Basel, Switzerland) · 2017Trial
- Predictive factors of successful endovascular recanalization for symptomatic atherosclerotic non-acute middle cerebral artery occlusion.Frontiers in neurology · 2025Article
- Article
- [Delayed cognitive impairment in patients with aortic stenosis treated with surgical valve replacement and transcatheter aortic valve implantation: a comparative study].Revista de neurologia · 2023Observational
- Effects of endovascular recanalization on symptomatic non-acute occlusion of intracranial arteries.Scientific reports · 2023Article
- Review
- Hemodynamic Changes in Patients with Chronic Internal Carotid Artery Occlusion After Recanalization.Neuropsychiatric disease and treatment · 2023Article
- Increased cerebrovascular reactivity in selected brain regions after extracranial-intracranial bypass improves the speed and accuracy of visual cancellation in patients with severe steno-occlusive disease: a preliminary study.Neurosurgical review · 2022Article
- Spotlight on clinical strategies of Chronic Internal Carotid Artery Occlusion: Endovascular interventions and external-intracarotid bypasses compared to conservative treatment.Frontiers in surgery · 2022Review
- Recanalization of the Chronically Occluded Internal Carotid Artery: Review of the Literature.World neurosurgery: X · 2020Review
- Microstructural damage pattern of vascular cognitive impairment: a comparison between moyamoya disease and cerebrovascular atherosclerotic disease.Neural regeneration research · 2019Article
- Endovascular Recanalization of Non-acute Symptomatic Middle Cerebral Artery Total Occlusion and Its Short-Term Outcomes.Frontiers in neurology · 2019Article
- Progression in Vascular Cognitive Impairment: Pathogenesis, Neuroimaging Evaluation, and Treatment.Cell transplantation · 2019Article
- Improved White Matter Cerebrovascular Reactivity after Revascularization in Patients with Steno-Occlusive Disease.AJNR. American journal of neuroradiology · 2019Article
- Hemodynamics and oxygen extraction in chronic large artery steno-occlusive disease: Clinical applications for predicting stroke risk.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2018Review
- High-flow bypass with radial artery graft followed by internal carotid artery ligation for large or giant aneurysms of cavernous or cervical portion: clinical results and cognitive performance.Neurosurgical review · 2018Article
- The efficacy and safety of endovascular recanalization of occluded large cerebral arteries during the subacute phase of cerebral infarction: a case series report.Stroke and vascular neurology · 2017Article
- Limb-shaking TIA: on the borders of evidence-based medicine.Internal and emergency medicine · 2017Article
Corrections and comments
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Authors and funding
12 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveTo determine whether extracranial-intracranial (EC-IC) bypass can improve cognition over 2 years compared to best medical therapy alone in patients with symptomatic internal carotid artery (ICA) occlusion and increased oxygen extraction fraction (OEF) on PET.
methodsPatients underwent (15)O PET and were randomized if OEF ratio was >1.13 on the occluded side. Using blinded baseline and 2-year cognitive assessments, age-adjusted composite z scores were generated from subtests sensitive to right/left hemisphere plus global cognitive functioning. Multiple regression predicted 2-year cognitive change.
resultsEighty-nine patients were enrolled; 41 had increased OEF and were randomized. Two died, 2 were lost to follow-up, and 2 refused 2-year testing. Of the 35 remaining, 6 had ipsilateral stroke or death, leaving 13 surgical and 16 medical patients. Controlling for age, education, and depression, there was no difference in 2-year cognitive change between the medical and surgical arms (95% confidence interval -0.5 to 0.5, p = 0.9). In post hoc analysis of 26 patients with no stroke in the follow-up period, cognitive improvement was associated with less impaired PET OEF at baseline (p = 0.045).
conclusionCognitive improvement following bypass surgery was not superior to medical therapy among patients with recently symptomatic carotid occlusion and increased OEF. Among those with no recurrent stroke, less hemodynamic impairment at baseline was associated with greater cognitive gain in both groups. Reversing cognitive impairment in hemodynamic failure remains an open challenge. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with symptomatic ICA occlusion and increased OEF on PET, EC-IC bypass compared to no bypass does not improve cognitive function after 2 years.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.