Abstract A107: Endovascular Treatment Improves Cognitive Function in Non-Acute Intracranial Atherosclerotic Stenosis Patients: A Prospective Cohort Study

Background: Intracranial atherosclerotic stenosis (ICAS) is a significant risk factor for cognitive impairment, likely via hypoperfusion. Despite the growing number of studies on ICAS, the efficacy of endovascular treatment (EVT) in improving the cognitive function of ICAS patients remains uncertain. This study aims to explore (1) whether EVT can improve the cognitive function of ICAS patients, (2) the correlation between cerebral perfusion and cognitive impairment. Methods: We conducted a prospective cohort study (NCT06336174) of non-acute anterior circulation ICAS patients, assigned to EVT plus best medical treatment (EVT group) or best medical treatment alone (BMT group). Cognitive function was assessed using a battery of neuropsychological tests, and cerebral blood flow (CBF) was quantified using pseudo-continuous arterial spin labeling at baseline and 3-month follow-up. The efficacy of EVT on cognitive function was evaluated using linear mixed-effects models (LMM). Pearson correlation analysis was used to assess the correlation between cognitive changes and perfusion changes. Multivariate linear regression (MLR) was used to identify the predictors of cognitive improvement (Figure 1). Results: 106 participants completed the follow-up, with the BMT group (n = 62, 42 males, age 55.62 ± 9.79, education 6.97 ± 3.76), and the EVT group (n = 44, 35 males, age 57.95 ± 8.20, education 6.42 ± 2.74). LMM analysis showed significant group × time interactions in immediate verbal memory (Auditory Verbal Learning Test, AVLT-immediate, F = 6.777, p = 0.011), working memory (Digit Span Test backward, F = 8.036, p = 0.005), and frontal lobe fluency (Verbal Fluency Test, semantic-VFT, F = 8.345, p = 0.005), which were primarily driven by significant improvements in the EVT group, as well as inter-group differences at follow-up (Figure 2). The EVT group showed significant improvement in CBF at follow-up, and this was correlated with better semantic-VFT performance (r = 0.568, p = 0.017) (Figure 3). MLR analysis showed that EVT improved neuropsychological scores, with greater effects in those with lower baseline scores. Conclusions: Endovascular treatment significantly improved cognitive function in non-acute ICAS patients, associated with the improvement in CBF, particularly in those with worse baseline cognitive performance. Further studies with larger sample sizes and longer follow-up are needed to confirm the long-term benefits and to explore the underlying mechanisms.