Medical Management Is Superior to Stenting for Intracranial Arterial Stenosis

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 …