The Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke (SAMMPRIS), a randomized controlled trial comparing angioplasty and stenting versus medical management for intracranial arterial stenosis, was stopped early due a high 30 day stroke or death rate in the intervention arm, and better than expected outcome for medical management. Derdeyn and colleagues recently critically evaluated contributing factors, reporting a significantly higher hemorrhage rate at low enrolling sites (9.8%) compared to high enrolling sites (2.7%), but no significant difference in hemorrhagic or ischemic complications related to specialty, operator experience, years in practice or number of SAMMPRIS cases. These results may argue for centralization of these procedures at high volume, specialty centers. The authors highlight the need to focus on interventions for subgroups in SAMMPRIS that had a high risk of stroke despite aggressive medical therapy.
Journal of NeuroInterventional Surgery