title: Stenting versus aggressive medical therapy for intracranial arterial stenosis.
abstract: BACKGROUND
  Atherosclerotic intracranial arterial stenosis is an important cause of stroke that is increasingly being treated with percutaneous transluminal angioplasty and stenting (PTAS) to prevent recurrent stroke. However, PTAS has not been compared with medical management in a randomized trial.
  
  
  METHODS
  We randomly assigned patients who had a recent transient ischemic attack or stroke attributed to stenosis of 70 to 99% of the diameter of a major intracranial artery to aggressive medical management alone or aggressive medical management plus PTAS with the use of the Wingspan stent system. The primary end point was stroke or death within 30 days after enrollment or after a revascularization procedure for the qualifying lesion during the follow-up period or stroke in the territory of the qualifying artery beyond 30 days.
  
  
  RESULTS
  Enrollment was stopped after 451 patients underwent randomization, because the 30-day rate of stroke or death was 14.7% in the PTAS group (nonfatal stroke, 12.5%; fatal stroke, 2.2%) and 5.8% in the medical-management group (nonfatal stroke, 5.3%; non-stroke-related death, 0.4%) (P=0.002). Beyond 30 days, stroke in the same territory occurred in 13 patients in each group. Currently, the mean duration of follow-up, which is ongoing, is 11.9 months. The probability of the occurrence of a primary end-point event over time differed significantly between the two treatment groups (P=0.009), with 1-year rates of the primary end point of 20.0% in the PTAS group and 12.2% in the medical-management group.
  
  
  CONCLUSIONS
  In patients with intracranial arterial stenosis, aggressive medical management was superior to PTAS with the use of the Wingspan stent system, both because the risk of early stroke after PTAS was high and because the risk of stroke with aggressive medical therapy alone was lower than expected. (Funded by the National Institute of Neurological Disorders and Stroke and others; SAMMPRIS ClinicalTrials.gov number, NCT00576693.).
authors: Department of Neurosciences, Medical University of South Carolina, Charleston, SC 29425, USA. mchimow@musc.edu
authors: Marc I
authors: MI
authors: Chimowitz
authors: Michael J
authors: MJ
authors: Lynn
authors: Colin P
authors: CP
authors: Derdeyn
authors: Tanya N
authors: TN
authors: Turan
authors: David
authors: D
authors: Fiorella
authors: Bethany F
authors: BF
authors: Lane
authors: L Scott
authors: LS
authors: Janis
authors: Helmi L
authors: HL
authors: Lutsep
authors: Stanley L
authors: SL
authors: Barnwell
authors: Michael F
authors: MF
authors: Waters
authors: Brian L
authors: BL
authors: Hoh
authors: J Maurice
authors: JM
authors: Hourihane
authors: Elad I
authors: EI
authors: Levy
authors: Andrei V
authors: AV
authors: Alexandrov
authors: Mark R
authors: MR
authors: Harrigan
authors: David
authors: D
authors: Chiu
authors: Richard P
authors: RP
authors: Klucznik
authors: Joni M
authors: JM
authors: Clark
authors: Cameron G
authors: CG
authors: McDougall
authors: Mark D
authors: MD
authors: Johnson
authors: G Lee
authors: GL
authors: Pride
authors: Michel T
authors: MT
authors: Torbey
authors: Osama O
authors: OO
authors: Zaidat
authors: Zoran
authors: Z
authors: Rumboldt
authors: Harry J
authors: HJ
authors: Cloft
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000188:drug therapy / Q000628:therapy*; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin