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Hemorrhagic stroke
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Cognitive outcomes after unruptured intracranial aneurysm treatment with endovascular coiling
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  • Published on: 26 July 2020
    Challenges and subtleties in the evaluation of post-procedural cognitive changes
    • Aravind Ganesh, Stroke and Cognitive Neurology Fellow Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Canada
    • Other Contributors:
      • Mohammed A. Al-Mekhlafi, Assistant Professor
      • Johanna M. Ospel, Radiology Resident
      • Mayank Goyal, Professor

    We congratulate Drs. Srivatsan and colleagues on their paper examining the effects of endovascular coiling of unruptured intracranial aneurysms (UIAs) on cognition using the Montreal Cognitive Assessment (MoCA).1 In particular, we appreciate the efforts made to sample the patients at multiple time points including pre-intervention and at 1-month and 6-months post-intervention. The study found that coiling did not diminish neurocognitive function per the MoCA, with there also being no correlation between follow-up MoCA scores and imaging findings, the overall results being comparable to the authors’ previous paper on MoCA scores following flow diversion for UIAs.2 Intriguingly, the MoCA scores at baseline were on average below the typical cut-off of 26 points, especially given the relatively young population (mean age 55.5 years).

    However, as acknowledged by the authors, the ability of the study to discern post-coiling imaging changes was limited by both the small subset of the population that received follow-up imaging (17 of 33 patients, 51.5%) and the smaller subset that underwent MRI (9 patients, 27.3%).1 Diffusion-weighted imaging (DWI) sequences of MRI are most sensitive to identifying post-procedural ischemic injury following neuro-interventional procedures like coiling.3 DWI lesions occur quite frequently; for example, in the ENACT trial (Evaluating Neuroprotection in Aneurysm Coiling Therapy), 68% of patients had new lesions post-procedure, with an average o...

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    Conflict of Interest:
    None declared.