Is There Benefit from Stenting on Cognitive Function in Intracranial Atherosclerosis?
Revascularization of stenotic cerebral arteries is hypothesized to improve cognition by increasing cerebral perfusion.



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.



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.



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.



Revascularization with PTAS showed no improvement in cognitive impairment over AMM alone among patients who did not have recurrent cerebrovascular events during follow-up.
Medical University of South Carolina, Charleston, S.C., USA.
Tanya N
TN
Turan
Alison
A
Smock
George
G
Cotsonis
David
D
Bachman
Sami
S
Al Kasab
Michael J
MJ
Lynn
Azhar
A
Nizham
Collin P
CP
Derdeyn
David
D
Fiorella
Scott
S
Janis
Bethany
B
Lane
Jean
J
Montgomery
Marc I
MI
Chimowitz
D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D009483:Neuropsychological Tests; D020127:Recovery of Function; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents