Intracranial Angioplasty and Stenting before and after SAMMPRIS: "From Simple to Complex Strategy - The Chinese Experience".

Zhongrong Miao

doi:10.3389/fneur.2014.00129

Abstract

Intracranial atherosclerotic disease (ICAD) accounts for 33–50% of all ischemic strokes in the Asian population (1) and represents an important public health issue in China. The results of the SAMMPRIS trial alarmed most experienced interventionalists in China for two reasons. Firstly, the high complication rate in the stenting arm (20% the first year) was higher than expected. Secondly, the recurrent stroke rate in the aggressive medical treatment arm at 12.2% during the first year was unacceptably high, not to mention the fact that such tight vascular risk factor control is difficult to achieve for many patients in real life clinical experience, at least in China. The experience of treating ICAD in China, gained over the last two decades, is very rich and promising. We intend to highlight these past experiences and address future trials and trends in China. We will also address our criticism of the SAMMPRIS trial design in order to better design a future trial.

Highlights

Zhongrong Miao*Beijing Tiantan Stroke Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
Intracranial atherosclerotic disease (ICAD) accounts for 33–50% of all ischemic strokes in the Asian population [1] and represents an important public health issue in China
INTRACRANIAL STENTING FOR ICAD IN CHINA BEFORE SAMMPRIS The warfarin–aspirin symptomatic intracranial disease (WASID) study showed that the role of medical therapy for intracranial atherosclerosis (≥70%) is less effective, with the 1-year risk of ischemic stroke remaining as high as 23% in patients who presented with stroke and 14% in patients who presented with transient ischemic attack (TIA) [2]

Summary

Zhongrong Miao*

Beijing Tiantan Stroke Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. We independently reported our prospective registry focused on symptomatic MCA stenosis, which demonstrated a relatively high 1-year complication rate of 19.4%, compared to the medical group of 17.6% (p = 0.85) [14] This result was very similar to the later published SAMMPRIS study. SINCE SAMMPRIS The publication of the SAMMPRIS [16] results, the first and only prospective randomized trial to date, demonstrated high complication rates in the first 30 days following the Wingspan stenting in one arm and lower than expected stroke risk in the aggressive medical treatment (AMT) arm. This changed the accepted belief of the www.frontiersin.org. Between November 2011 and October 2012, 158 patients were enrolled into the study

Secondary endpoints Any stroke or death

Findings

CONCLUSION