title: Impact of the New American Heart Association/American Stroke Association Definition of Stroke on the Results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial.
abstract: BACKGROUND
  An American Heart Association/American Stroke Association (AHA/ASA) writing committee has recently recommended that tissue evidence of cerebral infarction associated with temporary symptoms (CITS) lasting <24 hours should be considered a stroke. We analyzed the impact of considering CITS as equivalent to stroke on the results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial.
  
  
  METHODS
  We compared outcomes in the medical (n = 227) and stenting (n = 224) groups in SAMMPRIS using the following primary end point (new components in bold): any stroke, CITS, or death within 30 days after enrollment or within 30 days after a revascularization procedure for the qualifying lesion during follow-up; or ischemic stroke or CITS in the territory of the qualifying artery beyond 30 days. We also compared the use of brain magnetic resonance imaging (MRI) after transient ischemic attacks (TIAs) in both treatment groups.
  
  
  RESULTS
  By considering CITS as equivalent to stroke, the number of primary end points increased from 34 to 43 in the medical group and from 52 to 66 in the stenting group of SAMMPRIS. The Kaplan-Meier curves for the primary end points in the 2 groups were significantly different (P = .009). The percentage of patients with reported TIAs who underwent brain MRI was 69% in the medical group and 61% in the stenting group (P = .40).
  
  
  CONCLUSIONS
  Using the AHA/ASA definition of stroke resulted in a substantially higher primary end point rate in both treatment groups and an even higher benefit from medical therapy over stenting than originally shown in SAMMPRIS. The higher rate of CITS in the stenting group was not due to ascertainment bias.
authors.affiliation: Department of Neurology, Medical University of South Carolina, Charleston, South Carolina. Electronic address: alkasab@musc.edu.
authors.forename: Sami
authors.initials: S
authors.lastname: Al Kasab
authors.affiliation: Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public, Health, Atlanta, Georgia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lynn
authors.affiliation: Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Tanya N
authors.initials: TN
authors.lastname: Turan
authors.affiliation: Department of Radiology, University of Iowa, Iowa City, Iowa.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Derdeyn
authors.affiliation: Department of Neurosurgery, State University of New York, Stony Brook, New York.
authors.forename: David
authors.initials: D
authors.lastname: Fiorella
authors.affiliation: Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public, Health, Atlanta, Georgia.
authors.forename: Bethany F
authors.initials: BF
authors.lastname: Lane
authors.affiliation: National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
authors.forename: L Scott
authors.initials: LS
authors.lastname: Janis
authors.affiliation: Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Marc I
authors.initials: MI
authors.lastname: Chimowitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D001921:Brain / Q000000981:diagnostic imaging; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012008:Recurrence; D055502:Secondary Prevention; D015607:Stents; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States
keywords: Stroke; TIA; clinical trial; intracranial atherosclerosis