Effect of a Balloon-Expandable Intracranial Stent vs Medical Therapy on Risk of Stroke in Patients With Symptomatic Intracranial Stenosis

Abstract

Intracranial arterial stenosis is a common stroke etiology worldwide.^1-6 The recurrent stroke risk with severe symptomatic intracranial stenosis (≥70%) may be as high as 23% at 1 year, despite medical therapy.^7,8 Endovascular options are limited to balloon angioplasty only, self-expanding stent, balloon-expanding stent, or a combination of these therapies. The SAMMPRIS (Stenting and Aggressive Medical Therapy for Preventing Recurrent Stroke in Intracranial Stenosis) trial showed that aggressive medical therapy alone was superior to percutaneous transluminal balloon angioplasty followed by stenting using the Wingspan self-expanding stent (Stryker) with an absolute difference of 8.9% at 30 days and 9.0% at 3 years in the primary outcome.^9-11 The 30-day event rates with medical therapy were nearly one-half of the reported event rates in the WASID (Warfarin-Aspirin Symptomatic Intracranial Disease) trial and the balloon angioplasty with stenting results were nearly double the rates that were reported in prior stenting registries.^7,8,12-14