Introduction Stroke 80 ischemia Ischemic stroke 1 Unknown

Introduction • Stroke: 80% ischemia • Ischemic stroke: 1. Unknown etiology: 30 -40% 2. Carotid stenosis: 20 -25% 3. Af: 10% ( incidence in aged groups) 4. Major intracranial artery stenosis: 5 -10% Medicine 2017; 96(4): e 5999 衛服部統計處

Carotid Stenosis Natural History Asymptomatic (> 80%) carotid stenosis Dizziness, Syncope 6% risk of stroke / year Symptomatic (> 50%) carotid stenosis Major/ Minor stroke, Amaurosis fugax, TIA 10% risk of CVA at 1 year 40% risk of CVA at 5 years

Carotid Stenting Has been known: 1. An effective alternative Tx for stroke prevention National Heart Lung and Blood Insitute (NIH)

86/M, TIAs, Rt carotid stenosis MTT pre post 2 nd day

Carotid Stenting Has been known: 2. Additional positive effects: u Cerebral hemisphere & Brainstem Hemodynamics QOL Cognitive function– Sensory organ u How about ear? u u

Objectives n To quantitatively evaluate the influence of carotid stenting on Hearing function

Methods and Patients 1 n Inclusion l n Adult patients with carotid stenosis (70 -99%) admitted for carotid stenting Exclusion: l l Any history or current middle, inner ear Dz Contraindication of stenting (major disabling stroke on the ipsilateral side/disabling dementia/ thick calcification at the site of carotid stenosis) l Hemorrhagic or brainstem stroke

Methods and Patients 2 n Pre-stent post stent 6 M>post 6 M post Pre-stent/ 1 M 1 M post stent/ stent 1. PTA, SRT 2. DHI 3. SF-36

1. DHI (Dizziness Handicap Inventory): 25 items, 0 -2 -4 scores for each items, 0 -100 scores (Lower scores indicate better health status) A. Emotional well-beings: 9 items B. Functional activities: 9 items C. Physical activities: 7 items Acta Otolaryngol 2001; Suppl 545: 145– 154 Ann Otol Rhinol Laryngol 2001; 113: 1006 -11

2. SF-36 (Medical outcome study, 36 -Item Short-Form Health Survey): 36 items, 8 domains, 0 -100 scores (Higher scores indicate better health status) A. 4 Physical domains: Physical functioning; Role limitation due to physical problems; Bodily pain; Vitality B. 4 Emotional domains: General health perceptions; Social functioning; Role limitation due to emotional problems; Mental health Qual Life Res 2000; 9: 675 -83 J Vasc Surg 2001; 33(2): 329 -33

Results • Successful stenting in all 73 patients Patients with prior history of cancer included 12 (16. 4%) NPC, buccal cancer 3 (4. 1%), 1 (1. 4%) cancer of salivary gland, 1 (1. 4%) cancer of soft palate & NPC, 1 (1. 4%) cancer of tongue, 1 (1. 4%) laryngeal cancer, 1 (1. 4%) tonsillar cancer, 1 (1. 4%) thymoma, and 1 (1. 4%) right breast

Follow up: 21. 2 ( 8. 1) months

n Complications in 3: • 1 minor stroke, 1 TIA, 1 hyperperfusion syndrome good recovery without neurological sequelae

P=0. 05

Discussion 1 n Nonspecific dizziness in patients with hemodynamically significant carotid stenosis u 60. 3% (44/73) in our series − 14 -21% in the literature n J Am Geriatr Soc 1981; 29: 402 -6 Br Med J 1961; 2: 1057 -63 Risk factors for carotid stenosis u u Age, male, HTN, hyperlipidemia, smoking 27% (20/73) had H&N R/T in our series Medicine 2017; 96(4): e 5999 − 8 Y carotid a. stenosis 29% − 10 Y incidence of cerebrovascular event 25 -34% in R/T Oral Oncol 2018; 80: 9 -15 Intervent Neurol 2013; 2: 183– 192

Discussion 2 n No hearing ability change in our series n Carotid endarterectomy (CEA) could improve auditory acuity J Vasc Surg 2015; 62: 635 -44 at all tested frequencies

n Postulation: re-vascularizing the carotid artery will perfusion in the inner ear and the auditory pathway n Auditory cortex (area 41, 42, 22)? Patency of a-com, p-com? n J Vasc Surg 2015; 62: 635 -44 AJNR 2003; 24: 456– 462

Discussion 3 n Qo. L can be improved by carotid stenting 1. DHI − Physical subscale, Functional subscale − Our series: Emotional subscale 2. SF-36 − Our series: Physical function, Physical role limitation, Emotional role limitation − General Health, Social function JCMA 2014; 77: 403 -408 J Vasc Surg 2005; 42: 213 e 9 JACC Cardiovasc Interv 2010; 3: 515 e 23 J Am Coll Cardiol 2011; 58: 1557 e 65

Conclusion 1. Nonspecific dizziness (asymptomtic) present in a number of patients with hemodynamically significant carotid stenosis n Risk factors……. 2. Carotid stenting n in SF 36 (PF, RP, RE) n in DHI (emotional domain) n No change on PTA SRT, ipsi or contra

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