Is there benefit from stenting on cognitive function in intracranial atherosclerosis?

• Type of Material: Article
• Authors: Tanya N. Turan, Medical University of South Carolina; Alison Smock, Medical University of South Carolina; George A Cotsonis, Emory University; David Bachman, Medical University of South Carolina; Sami Al Kasab, Medical University of South Carolina; Michael Lynn, Emory University; Azhar Nizham, Emory University; Colin P. Derdeyn, University of Iowa Hospitals and Clinic; David Fiorella, Stony Brook University; Scott Janis, National Institute of Neurological Disorders and Stroke; Bethany Lane, Emory University; Jean Montgomery, Emory University; Marc I. Chimowitz, Medical University of South Carolina
• Language: English
• Date: 2017-02-01
• Publisher: Karger Publishers
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 S. Karger AG, Basel.
• Final Published Version (URL): http://dx.doi.org/10.1159/000450964
• Title of Journal or Parent Work: Cerebrovascular Diseases
• ISSN: 1015-9770
• Volume: 43
• Issue: 1-2
• Start Page: 31
• End Page: 35
• Grant/Funding Information: SAMMPRIS was funded by the National Institute of Neurological Disorders and Stroke (NINDS) U01 NS058728.
• Keywords: angioplasty and stenting; cognition; revascularization; stroke; intracranial stenosis
• Research Categories: Health Sciences, Medicine and Surgery; Psychology, Cognitive

Abstract

Background: Revascularization of stenotic cerebral arteries is hypothesized to improve cognition by increasing cerebral perfusion. Aims: We compared cognition impairment among patients treated with percutaneous angioplasty and stenting (PTAS) and aggressive medical management (AMM) versus AMM alone in the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) Trial. Methods: In SAMMPRIS, 451 patients with recent transient ischemic attack or stroke attributed to 70-99% intracranial stenosis were randomized to PTAS plus AMM or AMM alone. Patients who had stroke as the qualifying event with National Institutes of Health Stroke Scale indicating aphasia or neglect were excluded from these analyses. Patients with a cerebrovascular event (ischemic stroke, cerebral infarct with temporary signs or intracranial hemorrhage) during follow-up were excluded from follow-up visit analyses. The Montreal Cognitive Assessment (MoCA) score was used to assess cognition impairment at baseline, 4 months, 12 months and closeout. Cognitive impairment was defined as MoCA < 26. Mean MoCA scores and the percentage of patients with cognitive impairment were compared between treatment groups at each time point using t tests and chi-square tests. Differences in MoCA mean at baseline and follow-up time points were compared using mixed model repeated measures ANOVA and Tukey-Kramer tests. Results: There were no significant differences between the treatment groups for mean MoCA at any time point. Mean MoCA scores improved in both groups. The percentage of patients with cognitive impairment in the AMM versus PTAS groups was not significantly different at any time point. Conclusions: Revascularization with PTAS showed no improvement in cognitive impairment over AMM alone among patients who did not have recurrent cerebrovascular events during follow-up.