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. 2017 Aug;48(8):2158-2163.
doi: 10.1161/STROKEAHA.116.016254. Epub 2017 Jul 5.

Challenges in the Medical Management of Symptomatic Intracranial Stenosis in an Urban Setting

Rajbeer S Sangha  1 , Andrew M Naidech  1 , Carlos Corado  1 , Sameer A Ansari  1 , Shyam Prabhakaran  2
Affiliations

Challenges in the Medical Management of Symptomatic Intracranial Stenosis in an Urban Setting

Rajbeer S Sangha et al. Stroke. 2017 Aug.

Abstract

Background and purpose: Since the SAMMPRIS trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis), aggressive medical management (AMM), which includes dual antiplatelet therapy (DAPT) and high-dose statin (HDS) therapy, is recommended for patients with symptomatic intracranial atherosclerotic disease. However, limited data on the real-world application of this regimen exist. We hypothesized that recurrent stroke risk among patients treated with AMM is similar to the medical arm of the SAMMPRIS cohort.

Methods: Using a prospective registry, we identified all patients admitted between August 2012 and March 2015 with (1) confirmed ischemic stroke or transient ischemic attack; (2) independently adjudicated symptomatic intracranial atherosclerotic disease; and (3) follow-up at 30 days. We analyzed 30-day risk of recurrent ischemic stroke stratified by treatment: (1) AMM: DAPT plus HDS therapy, (2) HDS alone, and (3) DAPT alone. We also assessed 30-day risk among patients who met prespecified SAMMPRIS eligibility criteria.

Results: Among 99 patients who met study criteria (51.5% male, 54.5% black, mean age 68.2±11.2 years), 49 (48.5%) patients were treated with AMM, 69 (69.7%) with DAPT, and 73 (73.7%) with HDS therapy. At 30 days, 20 (20.2%) patients had recurrent strokes in the territory of stenosis. Compared with the risk in the medical arm of SAMMPRIS (4.4%), the 30-day risk of recurrent stroke was 20.4% in AMM patients, 21.5% in HDS patients, 22.4% in DAPT patients, and 23.2% in SAMMPRIS-eligible patients (all P<0.001).

Conclusions: Recurrent stroke risk within 30 days in patients with symptomatic intracranial atherosclerotic disease was higher than that observed in the medical arm of SAMMPRIS even in the subgroup receiving AMM. Replication of the SAMMPRIS findings requires further prospective study.

Keywords: acute stroke; stenosis; therapy; transient ischemic attack.

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Figures

Figure one
Figure one
Flowchart of study cohort assembly
Figure two
Figure two
30-day risk of recurrent stroke in the territory of the symptomatic stenotic artery overall and by subgroups and compared to the medical arm of SAMMPRIS
See this image and copyright information in PMC

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