scholarly journals Response to Critique of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) Trial by Abou-Chebl and Steinmetz

Stroke ◽  
2012 ◽  
Vol 43 (10) ◽  
pp. 2806-2809 ◽  
Author(s):  
Marc I. Chimowitz ◽  
David Fiorella ◽  
Colin P. Derdeyn ◽  
Tanya N. Turan ◽  
Bethany F. Lane ◽  
...  
Keyword(s):  
Medical Management ◽  
Recurrent Stroke ◽  
Intracranial Stenosis ◽  
Aggressive Medical Management

scholarly journals Clopidogrel plus Aspirin for Symptomatic Intracranial Atherosclerotic Stenosis: A Pilot Study

2016 ◽  
Vol 5 (3-4) ◽  
pp. 157-164 ◽  
Author(s):  
Tareq Kass-Hout ◽  
Melanie Winningham ◽  
Omar Kass-Hout ◽  
Laura Henriquez ◽  
Frank Tong ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Medical Management ◽  
Dual Antiplatelet Therapy ◽  
Recurrent Stroke ◽  
Intracranial Stenosis ◽  
Atherosclerotic Disease ◽  
Vascular Events ◽  
Intracranial Atherosclerotic Disease ◽  
Atherosclerotic Stenosis ◽  
Aggressive Medical Management

Background and Purpose: There are limited data on the optimal duration of dual antiplatelet therapy for secondary stroke prevention in patients with symptomatic intracranial atherosclerotic disease. Methods: Consecutive patients presenting with high-grade (70-99%) symptomatic intracranial stenosis from January 1, 2011, to December 31, 2013, and evaluated within 30 days of the index event were eligible for this analysis. All patients underwent treatment with aspirin plus clopidogrel for a target duration of 12 months along with aggressive medical management based on the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) protocol; all patients were given gastrointestinal prophylaxis for the duration of their aspirin and clopidogrel treatment. Clinical and safety outcomes of our cohort were compared with the medical arm of the SAMMPRIS trial cohort (n = 227). Results: Our cohort included 25 patients that met the inclusion criteria. Achievement of blood pressure and LDL cholesterol targets were similar between our cohort and the SAMMPRIS cohort. At 1 year, the rates of stroke, myocardial infarction or vascular death were 0% in our cohort and 16% in the SAMMPRIS cohort (p = 0.03). At 1 year, major bleeding rates were similar between our cohort and the SAMMPRIS cohort (4 vs. 2.2%, p = 1.0). Conclusion: A prolonged course of dual antiplatelet therapy for symptomatic intracranial atherosclerotic disease may be associated with less vascular events with no increase in hemorrhagic complications.

Revisiting Angioplasty Without Stenting for Symptomatic Intracranial Atherosclerotic Stenosis After the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) Study

Neurosurgery ◽  
2012 ◽  
Vol 71 (6) ◽  
pp. 1103-1110 ◽  
Author(s):  
Travis M. Dumont ◽  
Peter Kan ◽  
Kenneth V. Snyder ◽  
L. Nelson Hopkins ◽  
Adnan H. Siddiqui ◽  
...  
Keyword(s):  
Medical Management ◽  
Recurrent Stroke ◽  
Case Series ◽  
Intracranial Stenosis ◽  
Event Free Survival ◽  
Ischemic Event ◽  
Free Survival ◽  
One Year ◽  
Aggressive Medical Management

ABSTRACT BACKGROUND: The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study stopped recruiting patients because of higher-than-expected perioperative morbidity of primary stenting in patients with symptomatic intracranial stenosis. An alternative treatment, submaximal angioplasty without stenting, performed concurrently with SAMMPRIS, may offer revascularization benefits with a lower incidence of stenting-related risks. OBJECTIVE: To present the results of a consecutive case series of primary submaximal angioplasty procedures performed for symptomatic severe atherosclerotic intracranial stenosis refractory to medical treatment. METHODS: A database review identified primary submaximal angioplasty procedures performed in 41 patients for the treatment of >70% intracranial stenosis associated with an acute, symptomatic ischemic event in the distribution of the diseased vessel. For results analysis, 30-day events were reported as a percentage of patients treated. One-year periprocedural and ischemic event--free survival was reported as a percentage of all patients treated and displayed graphically with a Kaplan-Meier survival curve. RESULTS: Three events in 41 patients included 1 intraprocedural vessel perforation, 1 reperfusion hemorrhage < 24 hours postoperatively, and 1 transient ischemic attack 3 months postprocedurally (30-day event rate, 2 of 41, 4.9%). Median clinical follow-up duration after submaximal angioplasty was 19 months, with ≥ 1 year of follow-up available for 32 patients. One-year perioperative and ischemic event-free survival was high (29 of 32 patients, 91%). CONCLUSION: In this series, periprocedural safety of submaximal angioplasty in the setting of acute, symptomatic atherosclerotic intracranial stenosis was demonstrated. Although direct comparison is impossible because many patients were ineligible for stenting procedures, the complication profile compares favorably with rates of identically defined event-free survival for patients randomized to the medical (88%) and surgical (77%) arms of SAMMPRIS despite the absence of aggressive medical management.

scholarly journals Design of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial

2011 ◽  
Vol 20 (4) ◽  
pp. 357-368 ◽  
Author(s):  
Marc I. Chimowitz ◽  
Michael J. Lynn ◽  
Tanya N. Turan ◽  
David Fiorella ◽  
Bethany F. Lane ◽  
...  
Keyword(s):  
Medical Management ◽  
Recurrent Stroke ◽  
Intracranial Stenosis ◽  
Aggressive Medical Management
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