Evidence-Based Answers

Evidence Central™ is an integrated web and mobile solution that helps clinicians quickly answer etiology, diagnosis, treatment, and prognosis questions using the latest evidence-based research.

Browse

Evidence Central for Mobile Devices

Evidence Central iOS iPhone iPad Android

Evidence Central from Unbound Medicine, available for iOS® and Android™, is optimized for each platform and features superior navigation, so answers are easy to find at the bedside or anywhere they’re needed. Learn More

Word of the Day

Medical therapy superior to stenting in preventing stroke recurrence for intracranial arterial stenosis

Clinical Question:
Does angioplasty and stenting decrease the risk of recurrent stroke in patients with significant intracranial arterial stenosis?

Bottom Line:
As compared with medical management alone, the addition of angioplasty and stenting increases the risk of early recurrent stroke in patients with significant intracranial arterial stenosis. (LOE = 1b)

Reference:
Chimowitz MI, Lynn MJ, Derdeyn CP, et al, for the SAMMPRIS Trial Investigators. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011;365(11):993-1003.  [PMID:21899409]

Study Design:
Randomized controlled trial (nonblinded)

Funding:
Industry + govt

Allocation:
Concealed

Setting:
Inpatient (any location) with outpatient follow-up

Synopsis:
This study enrolled patients with a transient ischemic attack or nondisabling stroke within the last 30 days attributed to stenosis of 70% to 99% of a major intracranial artery (internal carotid, middle cerebral, vertebral, or basilar artery). Patients were randomized, using concealed allocation, to receive medical therapy plus percutaneous transluminal angioplasty and stenting (PTAS) or medical therapy alone. In both groups, medical therapy consisted of 325 mg aspirin daily and 75 mg clopidogrel daily for 90 days, aggressive blood pressure and cholesterol management, and a lifestyle modification program. PTAS was performed by experienced neurointerventionists. Baseline characteristics of the 2 groups were similar and analysis was by intention to treat. The primary outcome was the combination of stroke or death within 30 days or stroke beyond 30 days. Enrollment in the trial was stopped early after interim analyses showed a significantly increased risk of the primary outcome in the PTAS group (probability at 30 days = 14.7% vs 5.8%; P = .002; probability at 1 year = 20% vs 12.2%; P = .009). This was driven by a higher rate of early strokes within 1 day to 6 days of stenting in the PTAS group and a lower than expected stroke rate in the medical management group. Rates of stroke beyond 30 days did not differ between the 2 groups, but follow-up is ongoing.

RSS FEED

Site Licenses

Site license

Site Licenses are available for schools, universities, hospitals, government agencies, and companies. For more information, contact us.