Stenting for Symptomatic Intracranial Atherosclerosis Leads to Harm

The VISSIT randomized trial tested an alternative stenting technology to the SAMMPRIS trial but had essentially the same finding: Stenting was significantly worse than medical therapy.

Large-artery atherosclerosis has long been viewed as the highest-risk cause of stroke. This elevated risk has spurred the development of stent technologies to treat severely stenotic intracranial atherosclerotic lesions. The first reported randomized trial of such treatment—SAMMPRIS—showed higher-than-expected rates of stroke after stenting and lower-than-expected rates with medical therapy, resulting in a 9% absolute reduction in risk for stroke or death with medical therapy alone compared with stenting.

After the SAMMPRIS results were released, the data safety monitoring board of the VISSIT trial halted enrollment. VISSIT was a multicenter randomized trial comparing medical therapy alone versus a balloon-expandable stent in patients with r…

Reviewing Author

Hooman Kamel, MD

Disclosures

Speaker’s bureauGenentech

Grant / Research supportNational Institutes of Health/National Institute of Neurological Disorders and Stroke; Michael Goldberg Stroke Research Fund

Editorial boardsPLOS One; Scientific Reports

Leadership positions in professional societiesNeurocritical Care Society (Research Committee Member)