Abstract DP194: Cognitive Outcomes in Symptomatic Intracranial Stenosis: A Post-hoc SAMMPRIS Analysis of Stenting versus Aggressive Medical Management

Introduction: Intracranial atherosclerotic disease (ICAD) is a leading cause of stroke, yet 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 further excluded to only include patients with symptomatic intracranial atherosclerotic stenosis with no periprocedural complications or stenting challenges. Cognitive outcomes between the stenting and aggressive medical management arms were 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, we analyzed 270 patients (stenting: 122, aggressive medical management: 152). The stenting group further 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.