Failure of Intracranial Stenting for Stroke Prevention

In previous clinical trials such as SAMMPRIS (NEJM JW Neurol Nov 2011 and N Engl J Med 2011; 365:993), angioplasty and stenting for severe intracranial arterial disease (ICAD) was not effective compared with intensive medical therapy. However, some clinicians have wondered whether more experienced interventionists and refined patient selection would provide evidence of benefit. This randomized trial from China enrolled patients with transient ischemic attack or nondisabling ischemic stroke and severe ICAD (70% to 99% stenosis). Patients were assigned to angioplasty with stenting plus medical therapy or medical therapy alone. Procedures were performed by centers with at least 30 such cases annually. To avoid the hyperacute period, when inter…