Intracranial Artery Stenting May Not Improve Cognitive Function: A Preliminary Study

permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Although cognitive decline in patients with extracranial ath-erosclerotic artery stenosis (ECAS) may be improved by carotid revascularization, 1 the effect of stenting on cognitive dysfunction in patients with intracranial atherosclerosis (ICAS) remains unknown. Although stent placement was not effective in improving overall outcomes of patients with ICAS, 2 the value of stenting may have to be reconsidered if the procedure alleviates cognitive dysfunction. We aimed to evaluate changes in cognitive function and perfusion after stent placement in ICAS patients. Consecutive patients undergoing stenting who (1) had significant stenosis (> 50%) in the major intracranial arteries and (2) received stenting by consensus of the stroke team (stent group) at the Asan Medical Center, from May 2009 to August 2011, were recruited. Patients who had embolic sources and those with severe cognitive dysfunction who could not undergo neuropsy-chology (NP) tests were excluded. Control subjects were sex-and age-matched with patients with the same condition, but who refused this procedure for personal reasons. All patients underwent NP evaluations on the day before the stenting (T0) and at the 12-month (T12) follow-up visit. This included Mini-Mental Status Examination (MMSE), Beck's depression inventory (BDI), and NP tests assessing: (1) attention and executive function—forward/backward digit span test, trail making test A & B (TMT-A&B), digit symbol test, and phonemic fluency test; (2) memory—Seoul Verbal Learning Test (SVLT) and Rey Complex Figure Test (RCFT), and (3) visuospatial and construc-tional function—the clock drawing test. The study was approved by our ethical committee, and all the patients provided informed consent. Diamox brain single-photon emission computed tomog-raphy (SPECT) was also performed at T0 and T12 in the stent group. 3 For statistics, the Mann-Whitney U test was used to estimate the differences among continuous variables, and the chi-square and Fisher exact test were used for categorical data. To evaluate the results of NP tests, the differences observed in each patient after 12 months (T12-T0, ΔT12) compared to baseline were calculated. The mean Δ values were compared between the groups. All statistical analyses were conducted using SPSS for Windows (version 18.0; Eleven patients (mean age: 57.3 years, range 48-73 years) with distal internal carotid artery (ICA) (n = 3), middle cerebral artery (MCA) (n=4), basilar artery (BA) (n= 2), and distal verte-bral artery (VA) (n =2) stenoses and 11 control subjects (mean age: 60.7 years, …