Stenting is now available for patients with intracranial arterial stenosis, an important cause of stroke. This procedure finally has been examined in a randomized trial, funded by the NIH and a device manufacturer. Patients with recent transient ischemic attacks or nondisabling strokes — attributed to intracranial arterial stenoses of 70% to 99% — received either "aggressive medical management" alone or the same management plus angioplasty and stenting. The qualifying artery was the middle cerebral in 44% of patients, internal carotid in 21%, basilar in 22%, and vertebral in 13%.
After 451 patients were randomized, the trial was stopped because of adverse outcomes in the stent group: At 30 days after enrollment, the primary endpoint (stroke or death) had occurred in 14.7% of stented patients and in 5.8% of medical-management patients — a highly significant difference; most strokes in stented patients occurred immediately after their procedures. Beyond 30 days, the ipsilateral stroke rate was 6% in both groups during average follow-up of 1 year.
Comment: In this study of patients with recently symptomatic intracranial arterial stenosis, medical management — consisting of aspirin, blood pressure treatment, lipid treatment, lifestyle modification, and a 3-month course of clopidogrel — clearly was superior to angioplasty plus stenting. Even discounting periprocedural strokes, stenting conferred no advantage during 1 year of follow-up.
— Allan S. Brett, MD
Published in Journal Watch General Medicine September 29, 2011
Chimowitz MI et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011 Sep 15; 365:993. (http://dx.doi.org/10.1056/NEJMoa1105335)
