P.083 Early and 30-day clinical and neuropsychological effects of
                        iatrogenic brain infarcts in the ENACT randomized-controlled trial

Background: Small brain infarcts are often seen on diffusion-weighted MRI(DWI) following surgical/endovascular procedures. Little is known about their clinical effects. We examined the association of iatrogenic infarcts with outcomes in the ENACT(Evaluating Neuroprotection in Aneurysm Coiling Therapy) trial of nerinetide in endovascular aneurysm repair. Methods: In this post-hoc analysis, we used multi-variable models to evaluate the association of presence/number of DWI iatrogenic infarcts with NIHSS(National Institutes of Health Stroke Scale), mRS(modified Rankin Scale), and cognitive/neuropsychological scores(30-minute battery) at 1-4 and 30-days post-procedure. We also related infarct number to a Z-score-derived composite outcome score(quantile regression). Results: Among 185 patients(median age:56,IQR:50-64), 124(67.0%) had iatrogenic infarcts(median:4,IQR:2-10.5). Nerinetide resulted in fewer infarcts. Patients with infarcts had lower Mini-Mental State Exam(MMSE) scores at 2-4 days(median:28 vs 29, adjusted-coefficient[acoef] per additional infarct:-1.11,95%CI:-1.88 to -0.34,p=0.005). Infarct number was associated with worse day-1 NIHSS(aOR for NIHSS≥1:1.07,1.02-1.12,p=0.009), day 2-4 mRS(adjusted common odds-ratio[aOR]:1.05,1.01-1.09,p=0.005) and MMSE(acoef:-0.07,-0.13 to -0.003,p=0.040), 30-day mRS(aOR:1.04,1.01-1.07,p=0.016) and Hopkins Verbal Learning Test scores(acoef:-0.21,-0.39 to -0.03,p=0.020), as well as worse composite scores at 1-4 and 30-days(acoef:-0.09,-0.15 to -0.03,p=0.006). Conclusions: Iatrogenic infarcts were associated with subtle differences in post-procedural(1-4 days) and 30-day outcomes in this middle-aged cohort. Future studies should use batteries of similar/greater granularity to validate optimal measures for short- versus long-term manifestations.

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Endovascular Aneurysm Repair and Outcome in Patients Unfit for Open Repair of Abdominal Aortic Aneurysm (EVAR Trial 2): Randomised Controlled Trial

Yearbook of Surgery ◽

10.1016/s0090-3671(08)70570-6 ◽

2006 ◽

Vol 2006 ◽

pp. 371-372

Author(s):

J.M. Seeger

Keyword(s):

Abdominal Aortic Aneurysm ◽

Randomised Controlled Trial ◽

Aortic Aneurysm ◽

Open Repair ◽

Controlled Trial ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic ◽

Randomised Controlled ◽

Aneurysm Repair

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Endovascular Aneurysm Repair Versus Open Repair in Patients With Abdominal Aortic Aneurysm (EVAR Trial 1): Randomised Controlled Trial

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70145-3 ◽

2006 ◽

Vol 2006 ◽

pp. 176-177

Author(s):

G.L. Moneta

Keyword(s):

Abdominal Aortic Aneurysm ◽

Randomised Controlled Trial ◽

Aortic Aneurysm ◽

Open Repair ◽

Controlled Trial ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic ◽

Randomised Controlled ◽

Aneurysm Repair

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Endovascular versus Open Repair of Abdominal Aortic Aneurysm in 15-Years’ Follow-Up of the UK Endovascular Aneurysm Repair Trial 1 (EVAR Trial 1): A Randomized Controlled Trial

50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know ◽

10.1201/9780429434020-11 ◽

2020 ◽

pp. 47-49

Author(s):

Juan Carlos Jimenez ◽

Samuel Eric Wilson

Keyword(s):

Randomized Controlled Trial ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Controlled Trial ◽

Endovascular Aneurysm Repair ◽

Randomized Controlled ◽

Abdominal Aortic ◽

The Uk ◽

Aneurysm Repair

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Memantine for cognitive impairment in multiple sclerosis: a randomized placebo-controlled trial

Multiple Sclerosis Journal ◽

10.1177/1352458510367662 ◽

2010 ◽

Vol 16 (6) ◽

pp. 715-723 ◽

Cited By ~ 57

Author(s):

JF Lovera ◽

E. Frohman ◽

TR Brown ◽

D. Bandari ◽

L. Nguyen ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Free Recall ◽

Controlled Trial ◽

Neuropsychiatric Symptoms ◽

Verbal Learning ◽

Self Report ◽

California Verbal Learning Test ◽

Cognitive Improvement ◽

Learning Test

Background: Memantine, an NMDA antagonist, is effective for moderate to severe Alzheimer’s disease. Objective: Determine whether memantine improves cognitive performance (CP) among subjects with multiple sclerosis (MS) and cognitive impairment (CI). Methods: This double-blind, randomized, placebo-controlled trial (Clinicaltrials.gov NCT00300716) compared memantine 10 mg twice a day (4 week titration followed by 12 weeks on the highest tolerated dose) with placebo. The primary outcome was the change from baseline to exit on the Paced Auditory Serial Addition Test (PASAT) and the California Verbal Learning Test-II (CVLT-II) Long Delay Free Recall (LDFR). Secondary outcomes included additional neuropsychological tests; self-report measures of quality of life, fatigue, and depression; and family/caregiver reports of subjects’ CI and neuropsychiatric symptoms. Results: The differences between the groups on the change on the PASAT (placebo—memantine = 0.0 correct responses, 95% CI 3.4, 3.4; p = 0.9) and on CVLT-II LDFR (placebo—memantine =—0.6 words, 95% CI —2.1, 0.8; p = 0.4) as well as on the other cognitive tests were not significant. Subjects on memantine had no serious adverse events (AEs) but had more fatigue and neurological AEs as well as, per family members’ reports, less cognitive improvement and greater neuropsychiatric symptoms than subjects on placebo. Conclusion: Memantine 10 mg twice a day does not improve CP in subjects with MS, ages 18—65, without major depression, who have subjective cognitive complaints and perform worse than one SD below the mean on the PASAT or on the California Verbal Learning Test-II (total recall or delayed free recall).

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