Cognitive Impact After Endovascular Thrombectomy for Large and Medium Vessel Occlusion

Introduction Endovascular thrombectomy (EVT) is the standard of care for patients with acute large (LVO) and medium vessel occlusion (MeVO) stroke. Functional outcomes after thrombectomy are assessed using the modified Rankin Scale (mRS), which primarily measures the ability to function independently. To date, few studies have investigated the long‐term cognitive outcomes following endovascular therapy for acute ischemic stroke. Methods Prospective, single‐center cohort study of acute ischemic patients without pre‐stroke cognitive impairment, based on AD‐8 questionnaire, and baseline mRS of 0‐2, treated with EVT for LVO or MeVO, and achieving 2b‐3 reperfusion on the Thrombolysis in Cerebral Infarction (TICI) scale and discharge mRS 0‐4. Patients with life expectancy <6 months and parenchymal hematoma type 2 were excluded. Primary objective was to assess post stroke cognitive function at one, three, and six months using the Montreal Cognitive Assessment (MoCA). The primary outcomes included: incidence of cognitive impairment, defined as MoCA <26 at 6 months; trends in cognitive outcomes at 1, 3, and 6 months; and determine whether cognitive outcome is associated with functional outcome and major depression, defined as Beck Depression Inventory (BDI) score >20. Results We performed an interim analysis of our initial 12 patients. Mean age was 69 years (±19); 9 (75%) were female. The mean mRS at discharge was 1.7 (±1.8). At 1‐month follow‐up, 9 patients (75%) were evaluated. The mean mRS was 1.2 (±1), and the mean MoCA was 23.7 (±5.3). Five patients (56%) met criteria for cognitive impairment. At 3‐month follow‐up, 7 patients (58%) were evaluated. The mean mRS was 1.4 (±1.6), and the mean MoCA was 25.1 (±4.6). Four patients (57%) met criteria for cognitive impairment. At 6‐month follow‐up, 3 patients (25%) were evaluated. The mean mRS was 0 (±0), and the mean MoCA was 26.3 (±3.8). One patient (33%) met criteria for cognitive impairment. Major depression was not observed at 1‐, 3‐, or 6‐month follow‐up. Conclusion The preliminary data suggest that cognitive impairment is common in the early months following EVT, with more than half of patients meeting criteria for cognitive impairment at one‐ and three‐month follow‐up. There is a trend toward cognitive improvement over time. The mean mRS was less than 2 at one‐, three‐, and six‐month follow‐up, indicating favorable motor and functional recovery. These findings suggest that cognitive recovery may lag behind functional gains, underscoring the importance of dedicated cognitive assessments in the post‐stroke period. The study also highlights the need for closer cognitive monitoring, as functional independence may mask subtle but clinically significant cognitive deficits. Further enrollment and follow‐up are needed to confirm our preliminary findings.