1049. Cognitive Outcomes after Intracranial Aneurysm Treatment with Flow Diversion

Authors: Kathryn Wagner, MD; Aditya Srivatsan, BS; Alina Mohanty, BS; Visish Srinivasan, MD; Jacob Cherian, MD; Robert James, MD; Stephen Chen, MD; Jeremiah Johnson, MD; Peter Kan, MD (Houston, TX)

Introduction:

Flow diversion is increasingly used to treat a variety of intracranial aneurysms with good efficacy and outcomes. However, there is radiographic evidence this treatment is maybe associated with a larger burden of radiographic thromboembolic events compared to other endovascular modalities. The clinical significance of these changes remains unknown. In this study, we present neurocognitive performance of a cohort of patients before and after endovascular aneurysm treatment with flow diversion. This is the first study of cognitive outcomes after aneurysm treatment with flow diversion.

Methods:

We prospectively collected data on cognitive function using the Montreal Cognitive Assessment (MoCA) tool in patients undergoing endovascular aneurysm treatment with flow diversion. Patients completed the MoCA prior to intervention, at one month after treatment, and again at six months after the procedure. All patients with aneurysms treated with flow diversion were included, regardless of age, functional status, aneurysm location or morphology. A repeated measures linear mixed effects model was used to compare pre-intervention and post-intervention cognitive status at the time intervals outlined.

Results:

Thirty patients who underwent endovascular aneurysm treatment with flow diversion from June 2017-present had pre and post-treatment MOCA scores. There was no difference between baseline and post-procedure MoCA score at any time interval (p>0.05). The MoCA score at baseline, one month post-procedure, and six months post-procedure was 26.1, 26.2, and 25.5 respectively. There was also no difference between pre- and post- procedure score on any individual domain of the instrument (Visuospacial. Naming, Memory, Attention, Language, Abstraction, Delayed recall, and Orientation, p>0.05).

Conclusion:

Flow diversion is increasingly used in the treatment of intracranial aneurysms. While there may be radiographic evidence of small silent ischemic changes on MRI after treatment, our study suggests that this does not alter neurocognitive function. Larger patient samples and longer follow up are needed to confirm these findings.