Abstract
Evaluation of: Chimowitz MI, Lynn MJ, Howlett-Smith H et al.: Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. New Engl. J. Med. 352(13), 1305–1316 (2005). Management of patients with intracranial stenosis had been previously based on retrospective data. This prospective, randomized, multicenter trial evaluated warfarin versus aspirin for the secondary prevention of stroke in patients with angiographically verified intracranial stenosis of 50% or greater. Enrollment was stopped early owing to excessive bleeding complications and all-cause mortality in the warfarin arm. There was also no observed significant difference in stroke rates. Contrary to prior data, this study showed that patients with symptomatic intracranial stenosis should be treated with aspirin. Prospective, randomized trials are needed to determine whether intravascular interventions, such as angioplasty or stenting, will offer more protection against stroke in this setting.
Published Version
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