Introduction The impact of treatment modality on cognitive function is not well established. In this post‐hoc analysis of the SAMMPRIS trial, we compare cognitive outcomes in patients with symptomatic ICAD managed with percutaneous transluminal angiographic stenting to those treated with aggressive medical management. Methods Using the SAMMPRIS trial sample of 451 patients, we included patients who underwent successful symptomatic intracranial atherosclerotic stenosis (i.e. no periprocedural complications or stenting challenges) along with those those treated with aggressive medical management. Cognitive outcomes between the stenting and aggressive medical management arms were then assessed using the Montreal Cognitive Assessment (MoCA) at 30 days, 4 months, 12 months, and final follow‐up. Multivariate linear and logistic regression models were used to adjust for baseline MoCA score, age, sex, and vascular risk factors. Results Following exclusion for non‐successful stenting, we analyzed 270 patients (stenting: 122, aggressive medical management: 152). The stenting group exhibited significantly reduced odds of achieving MoCA ≥ 26 compared to the medical management group (OR 0.54, 95% CI 0.29 to 1.00, p=0.050), representing a 54% higher likelihood of reaching sub‐normal cognitive outcome. Despite higher baseline cognitive function in the stenting group (median MoCA 26 vs 25, p=0.019), no significant difference was observed in continuous MoCA scores between patients receiving stenting and medical management (OR ‐0.63, 95% CI ‐1.60 to 0.34, p=0.205). Conclusion Stenting was associated with decreased long‐term cognitive outcomes relative to symptomatic ICAD treated with aggressive medical therapy. By raising concern about potential cognitive harm from interventional management, these findings highlight the importance of including cognitive outcomes as a factor in treatment selection.
Trad et al. (Sat,) studied this question.