Hemodynamic, neurological, and cognitive outcomes after surgical revascularisation in occlusive cerebrovascular disease: Study protocol for single-arm interventional cohort study.

BACKGROUND: Chronic carotid artery occlusive disease is associated with a high risk of ischemic events and long-term neurological deficits. Optimising surgical revascularisation outcomes requires an integrated understanding of anatomical, hemodynamic, and functional factors. This study aims to assess the neuro-radiological, clinical, and cognitive outcomes following cerebral revascularisation in patients with chronic internal carotid artery occlusion. METHODS: This single-centre, prospective, open-label interventional longitudinal study includes 60 patients with chronic internal carotid artery occlusion undergoing superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass at National Centre for Neurosurgery in Kazakhstan. The primary endpoint of the study is the incidence of ischemic stroke during the 6-month follow-up period after surgery. Pre- and postoperative evaluations include detailed angiographic assessment of collateral circulation and donor vessel diameter, as well as cerebral perfusion imaging using arterial spin labelling MRI. Neurological and cognitive function are assessed using standardized clinical and neuropsychological tests. Early and six-month follow-up evaluations focus on bypass patency, perfusion changes, and clinical outcomes. DISCUSSION: By integrating anatomical, hemodynamic, and functional data, this study aims to identify predictors of successful revascularisation and favorable clinical outcomes. Correlation of postoperative angiographic and perfusion findings with cognitive and neurological recovery may refine surgical decision-making, enhance risk stratification, and optimize individualized patient care. Ultimately, this comprehensive approach seeks to improve the overall efficacy and safety of STA-MCA bypass in patients with chronic carotid artery occlusive disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT07396025. Registered on February 5, 2026.