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Abstract and Introduction
Abstract
Objective There are few data regarding the effect of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial results on the management of intracranial atherosclerotic disease (ICAD). We sought to understand the impact of the SAMMPRIS trial on current ICAD clinical practices and future trial design.
Methods During the ICAD symposium at the 2012 International Stroke Conference, electronic data were collected regarding attendees' clinical management of ICAD and opinions on the feasibility of future trials post-SAMMPRIS.
Results 217 attendees from different specialties, including neurologists (57%), neurointerventionalists (9%) and neurosurgeons (5%), participated in the session. The majority of respondents (77%) indicated that the results of SAMMPRIS have impacted their consideration for intracranial stenting. Post-SAMMPRIS, 84% selected 'SAMMPRIS-style' medical management for the treatment of ICAD. For patients with ICAD who failed aggressive medical therapy, 82% would consider an alternative approach to continuing medical therapy (30% considered clinical trial enrollment, 28% suggested angioplasty and stenting and 24% angioplasty). The majority of participants (85%) were willing to randomize patients with symptomatic ICAD in future trials. For the next ICAD trial, 29% indicated that angioplasty alone should be compared with aggressive medical therapy.
Conclusions Our polling results suggest that the SAMMPRIS trial has had an impact on the current treatment of ICAD. Treatment of patients who failed medical therapy varied widely from aggressive medical therapy to balloon angioplasty, stenting or enrollment in future clinical trials. The willingness to continue clinical trials and randomize patients supports the need for future ICAD studies.
Introduction
The recent results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial demonstrated the superiority of aggressive medical management over stent-supported angioplasty with the Wingspan stent system in patients with recently symptomatic high-grade stenosis (≥70%). A high 30-day rate (14.7%) of stroke or death was seen in patients randomized to intracranial stent placement compared with medical treatment alone (5.8%). Limited data exist concerning the impact of the SAMMPRIS trial results on the current clinical treatment of intracranial atherosclerotic disease (ICAD).
At the 2012 International Stroke Conference (ISC), polling questions were conducted at the beginning of the ICAD symposium using an audience response system to evaluate opinions among neurologists, neurointerventionalists and other professionals. The questions were designed to evaluate the impact of the SAMMPRIS trial on physician management of ICAD and the feasibility of future ICAD trials.
A total of 217 participants attended the session and, on average, 179 attendees responded to each polling question. We believe that the following results of our poll objectively quantify the opinions on the field of ICAD post-SAMMPRIS.
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