title: Design of the stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis trial.
abstract: BACKGROUND
  Patients with recent transient ischemic attack (TIA) or stroke caused by 70% to 99% stenosis of a major intracranial artery are at high risk of recurrent stroke on usual medical management, suggesting the need for alternative therapies for this disease.
  
  
  METHODS
  The Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis trial is an ongoing, randomized, multicenter, 2-arm trial that will determine whether intracranial angioplasty and stenting adds benefit to aggressive medical management alone for preventing the primary endpoint (any stroke or death within 30 days after enrollment or after any revascularization procedure of the qualifying lesion during follow-up, or stroke in the territory of the symptomatic intracranial artery beyond 30 days) during a mean follow-up of 2 years in patients with recent TIA or stroke caused by 70% to 99% stenosis of a major intracranial artery. Aggressive medical management in both arms consists of aspirin 325 mg per day, clopidogrel 75 mg per day for 90 days after enrollment, intensive risk factor management primarily targeting systolic blood pressure <140 mm Hg (<130 mm Hg in diabetics) and low density cholesterol <70 mg/dL, and a lifestyle modification program. The sample size required to detect a 35% reduction in the rate of the primary endpoint from angioplasty and stenting based on the log-rank test with an alpha of 0.05, 80% power, and adjusting for a 2% loss to follow-up and 5% crossover from the medical to the stenting arm is 382 patients per group.
  
  
  RESULTS
  Enrollment began in November 2008 and 451 patients have been enrolled as of March 31, 2011.
  
  
  CONCLUSIONS
  This is the first randomized stroke prevention trial to compare angioplasty and stenting with medical therapy in patients with intracranial arterial stenosis and to incorporate intensive management of multiple risk factors and a lifestyle modification program in the study design. Hopefully, the results of the trial will lead to more effective therapy for this high-risk disease.
authors: Department of Neurosciences, Stroke Center, Medical University of South Carolina, Charleston, USA. mchimow@musc.edu
authors: Marc I
authors: MI
authors: Chimowitz
authors: Michael J
authors: MJ
authors: Lynn
authors: Tanya N
authors: TN
authors: Turan
authors: David
authors: D
authors: Fiorella
authors: Bethany F
authors: BF
authors: Lane
authors: Scott
authors: S
authors: Janis
authors: Colin P
authors: CP
authors: Derdeyn
mesh_terms: D017130:Angioplasty / Q000295:instrumentation*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000628:therapy*; D001241:Aspirin / Q000627:therapeutic use; D002539:Cerebral Arterial Diseases / Q000150:complications / Q000628:therapy*; D000077144:Clopidogrel; D003251:Constriction, Pathologic; D004359:Drug Therapy, Combination; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D018401:Sample Size; D055502:Secondary Prevention / Q000379:methods*; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin