Abstract W P382: Cognitive Outcome in SAMMPRIS: Medical Therapy vs. Stenting

Abstract

Background: It has been hypothesized that revascularization of stenotic cerebral arteries may improve cognitive outcome by increasing cerebral perfusion. We sought to compare cognitive outcome in patients treated with percutaneous angioplasty and stenting (PTAS) and aggressive medical management (AMM) vs. AMM alone in the SAMMPRIS Trial. Methods: In SAMMPRIS, 451 patients with recent TIA or stroke attributed to 70%-99% intracranial stenosis were randomized to PTAS plus AMM or AMM alone. Patients with stroke as the qualifying event who had a NIHSS indicating aphasia or neglect were excluded from these analyses. Patients with any ischemic stroke, cerebral infarct with temporary signs (CITS), or ICH during follow-up were excluded from subsequent follow-up visit analyses. The Montreal Cognitive Assessment (MoCA) score was used to assess cognition at baseline, 4 months, 12 months, and closeout (mean 3.05 years in AMM group and 3.12 years in PTAS group). 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 means from baseline to follow-up time points were compared using mixed model repeated measures ANOVA and Tukey-Kramer tests. Results: As shown in the Figure, there were no significant differences between the treatment groups for mean MoCA at any time point. There were significant improvements in mean MoCA from baseline to 4 months, 12 months, and closeout in both groups. The percentage of patients with cognitive impairment in the AMM vs. PTAS groups were not significantly different at baseline (53 vs. 56%), 4 months (38 vs. 44%), 12 months (42 vs. 40%), and closeout (43 vs. 39%). Conclusions: Revascularization did not provide any additional cognitive benefit over AMM alone in SAMMPRIS even after excluding patients who had cerebral infarction or ICH during follow-up.