Response to Critique of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) Trial by Abou-Chebl and Steinmetz

Abstract

See related article, p 2682. Even before the early results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial were published,1 commentaries that were critical of the trial or that attempted to explain the poor outcome of patients treated with stenting in the trial were published or being submitted for publication.2–4 Subsequent to the publication of the SAMMPRIS results, other commentaries soon followed.5–12 As the lead investigators of SAMMPRIS, we welcome the scientific debate on possible limitations of the trial and the implications of the results on management of patients with intracranial stenosis and the design of future trials of this high-risk disease. However, these opinions should be based on an accurate representation of the published data from the trial. The recent critique of SAMMPRIS in Stroke by Abou Chebl and Steinmetz12 fails in this regard. Their critique contains inaccurate references to the study data and protocol, incorrect derivations of event rates in the trial, and selective use of unpublished SAMMPRIS data presented at a scientific meeting. These unpublished data were used to support the authors' viewpoint, whereas other data from the same presentation that contradicted that viewpoint were omitted. The purpose of this article is to correct the deficiencies and errors in the critique of SAMMPRIS by Abou-Chebl and Steinmetz. ### Incorrect References In their critique, Abou-Chebl and Steinmetz claim that relationships between specific lesion and procedural variables and periprocedural complications were misrepresented in the SAMMPRIS primary article in the New England Journal of Medicine ( NEJM ). They write “Although in the publication of the SAMMPRIS trial the authors write that vessel size was not related to the risk of complications, there was a greater risk of ICH (10% versus 0%) if the prestent lesion diameter was …