Project 456839

Patients often end up with tiny strokes after surgery or minimally invasive procedures, like coiling for brain aneurysms. These tiny strokes can be seen on MRI scans. When they are caused by a procedure, they are termed "iatrogenic". While we don't know much about their effects in otherwise healthy people, we know that small strokes can cause memory problems when they build up over time in older people with vascular disease. Recent studies have indicated that iatrogenic strokes can cause similar problems, but no treatments have been shown to help with these problems. A randomized controlled trial, EVOLVE, is testing whether taking acetylsalicylic acid (ASA, also called aspirin) will reduce the number of strokes after aneurysm coiling. We want to follow these patients for up to a year after coiling to check whether treatment with ASA also results in better memory and mental health. All patients in the trial will have a brain MRI 12-48 hours after coiling. For our study, we will check the patients for temporary confusion, also called delirium, that can happen after operations. We will also do detailed tests of memory, thinking, and mental health before, shortly after, and up to 1 year after coiling. We will ask patients about their quality of life. We will ask their care partners about how the patients are doing in their daily life. We think that patients getting ASA will do better on the tests and have delirium less often. Based on our prior work, we also expect that patients with more iatrogenic strokes on their brain scan will do worse than those with fewer or no strokes. Our study will provide the most detailed knowledge of long-term effects of iatrogenic strokes until now. If we find that patients taking ASA do better on our tests, this will help change how we manage thousands of patients treated with procedures like coiling around the world. By understanding the effects of iatrogenic strokes, we can also become better at testing treatments to prevent them.