Abstract
We review the methods and results of Stenting and Aggressive Medical Management for Preventing Recurrent Stroke (SAMMPRIS) and provide a critical review of its strengths and limitations. In SAMMPRIS, the aggressive medical treatment arm (AMT arm) did substantially better than the Wingspan Stenting plus aggressive medical management arm (WS+ arm). Complications in the first 30 days post intervention led to the disparity between treatment arms. A major contribution of SAMMPRIS was the added value that AMT and lifestyle change may provide, when compared to a precursor trial, Warfarin–Aspirin Symptomatic Intracranial Disease (WASID), designed to prevent stroke in persons with high-grade symptomatic intracranial occlusive disease, however, the results of neither of these two trials have ever been reproduced. On the other hand, we argue that technical limitations of the Wingspan stent system (WS System) and lack of an angioplasty only intervention arm may have led to a premature launch of the trial and early termination of the study. Future randomized trials with different devices and modified patient selection criteria are warranted.
Highlights
An important intracranial stenting prevention trial in patients with symptomatic intracranial atherosclerotic occlusive disease, Stenting and Aggressive Medical Management for Preventing Recurrent Stroke (SAMMPRIS), was published [1]
SAMMPRIS METHODS AND STUDY DESIGN Stenting and Aggressive Medical Management for Preventing Recurrent Stroke is a Phase III, investigator-initiated, multicenter, randomized, open label, stroke prevention trial funded by National Institute of Neurological Disorders and Stroke (NINDS) to determine whether the WS System angioplasty and stenting arm (WS+ arm) and intensive medical therapy are superior to intensive medical therapy alone (AMT arm) for preventing stroke in recently symptomatic patients with severe intracranial atherosclerotic stenosis
There was no difference in main outcomes after 30 days of stroke, Kaplan– Meier curves were significantly different with 1-year rates of the primary endpoint between the WS arm (20.0%) and medical arm (12.2%, p = 0.009)
Summary
An important intracranial stenting prevention trial in patients with symptomatic intracranial atherosclerotic occlusive disease (sICAD), Stenting and Aggressive Medical Management for Preventing Recurrent Stroke (SAMMPRIS), was published [1]. SAMMPRIS showed that AMT alone was superior to the Wingspan system plus aggressive medical therapy (WS+ arm). The publication of the results, we believe, has reduced intracranial endovascular revascularization (IER) therapies leaving those patients with intracranial atherosclerotic stenosis who have failed medical management without an alternative treatment strategy despite a high risk of stroke, minimum 12.2%, in the first year. In this topical review, we discuss the main results and limitation of SAMMPRIS, and re-address the question as to whether or not the findings were really surprising based on prior scientific information. We discuss strategies to advance the field of IER
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