title: Intracranial stenosis: impact of randomized trials on treatment preferences of US neurologists and neurointerventionists.
abstract: OBJECTIVE
  Medical and endovascular treatment options for stroke prevention in patients with symptomatic intracranial stenosis have evolved over the past several decades, but the impact of 2 major multicenter randomized stroke prevention trials on physician practices has not been studied. We sought to determine changes in US physician treatment choices for patients with intracranial atherosclerotic stenosis (ICAS) following 2 NIH-funded clinical trials that studied medical therapies (antithrombotic agents and risk factor control) and percutaneous transluminal angioplasty and stenting (PTAS).
  
  
  METHODS
  Anonymous surveys on treatment practices in patients with ICAS were sent to physicians at 3 time points: before publication of the NIH-funded Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial (pre-WASID survey, 2004), 1 year after WASID publication (post-WASID survey, 2006) and 1 year after the publication of the NIH-funded Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial (post-SAMMPRIS survey, 2012). Neurologists were invited to participate in the pre-WASID survey (n=525). Neurologists and neurointerventionists were invited to participate in the post-WASID (n=598) and post-SAMMPRIS (n=2,080) surveys. The 3 surveys were conducted using web-based survey tools delivered by E-mail, and a fax-based response form delivered by E-mail and conventional mail. Data were analyzed using the χ2 test.
  
  
  RESULTS
  Before WASID, there was equipoise between warfarin and aspirin for stroke prevention in patients with ICAS. The number of respondents who recommended antiplatelet treatment for ICAS increased across all 3 surveys for both anterior circulation (pre-WASID=44%, post-WASID=85%, post-SAMMPRIS=94%) and posterior circulation (pre-WASID=36%, post-WASID=74%, post-SAMMPRIS=83%). The antiplatelet agent most commonly recommended after WASID was aspirin, but after SAMMPRIS it was the combination of aspirin and clopidogrel. The percentage of neurologists who recommended PTAS in >25% of ICAS patients increased slightly from pre-WASID (8%) to post-WASID surveys (12%), but then decreased again after SAMMPRIS (6%). The percentage of neurointerventionists who recommended PTAS in >25% of ICAS patients decreased from post-WASID (49%) to post-SAMMPRIS surveys (17%).
  
  
  CONCLUSIONS
  The surveyed US physicians' recommended treatments for ICAS differed over the 3 survey periods, reflecting the results of the 2 NIH-funded clinical trials of ICAS and suggesting that these clinical trials changed practice in the USA.
authors.affiliation: Medical University of South Carolina, Charleston, S.C., USA.
authors.forename: Tanya N
authors.initials: TN
authors.lastname: Turan
authors.forename: George
authors.initials: G
authors.lastname: Cotsonis
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lynn
authors.forename: Rahim H
authors.initials: RH
authors.lastname: Wooley
authors.forename: Seegar
authors.initials: S
authors.lastname: Swanson
authors.forename: Janice E
authors.initials: JE
authors.lastname: Williams
authors.forename: Barney J
authors.initials: BJ
authors.lastname: Stern
authors.forename: Colin P
authors.initials: CP
authors.lastname: Derdeyn
authors.forename: David
authors.initials: D
authors.lastname: Fiorella
authors.forename: Marc I
authors.initials: MI
authors.lastname: Chimowitz
mesh_terms: D017130:Angioplasty / Q000706:statistics & numerical data; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D002536:Cerebral Arteries / Q000473:pathology*; D000077144:Clopidogrel; D003251:Constriction, Pathologic; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019538:Health Care Surveys; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000473:pathology / Q000628:therapy*; D009462:Neurology / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015642:Radiology, Interventional; D016032:Randomized Controlled Trials as Topic; D040242:Risk Reduction Behavior; D055502:Secondary Prevention; D015607:Stents / Q000706:statistics & numerical data; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D014481:United States; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin