Stenting versus aggressive medical therapy for intracranial arterial stenosis

January 01, 0001

Stenting versus aggressive medical therapy for intracranial arterial stenosis

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. These US authors 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.

They found: "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%). 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, with 1-year rates of the primary end point of 20.0% in the PTAS group and 12.2% in the medical-management group."

The authors concluded: "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."

This study demonstrates how important it is to test new procedures and technologies in clinical trials before widespread adoption.

For the full abstract, click here.

N Engl J Med Published online 7 September 2011 © 2011 to the Massachusetts Medical Society
Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis. Marc I. Chimowitz, Michael J. Lynn, Colin P. Derdeyn, et al. Correspondence to Dr. Chimowitz: [email protected]

Category: K. Circulatory, N. Neurological. Keywords: stroke, secondary prevention, percutaneous transluminal angioplasty and stenting, intracranial artery stenosis, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 20 September 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.