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Original research
Impact of SAMMPRIS on the future of intracranial atherosclerotic disease management: polling results from the ICAD symposium at the International Stroke Conference
  1. Osama O Zaidat1,2,3,
  2. Alicia C Castonguay1,
  3. Thanh N Nguyen4,
  4. Kyra J Becker5,
  5. Colin P Derdeyn6,
  6. Peter K Nelson7,
  7. Pierre Amarenco8,
  8. Thomas G Brott9
  1. 1Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin, USA
  2. 2Department of Neurosurgery, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin, USA
  3. 3Department of Radiology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin, USA
  4. 4Departments of Neurology, Neurosurgery, Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
  5. 5Department of Neurology, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
  6. 6Center for Stroke and Cerebrovascular Disease, Washington University School of Medicine, St. Louis, Missouri, USA
  7. 7Departments of Radiology and Neurosurgery, New York University Medical Center, New York, New York, USA
  8. 8Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France
  9. 9Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
  1. Correspondence to Dr Osama O Zaidat, Departments of Neurology, Radiology, and Neurosurgery, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, WI 53226, USA; szaidat{at}mcw.edu

Abstract

Objective There are few data regarding the effect of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial results on the management of intracranial atherosclerotic disease (ICAD). We sought to understand the impact of the SAMMPRIS trial on current ICAD clinical practices and future trial design.

Methods During the ICAD symposium at the 2012 International Stroke Conference, electronic data were collected regarding attendees’ clinical management of ICAD and opinions on the feasibility of future trials post-SAMMPRIS.

Results 217 attendees from different specialties, including neurologists (57%), neurointerventionalists (9%) and neurosurgeons (5%), participated in the session. The majority of respondents (77%) indicated that the results of SAMMPRIS have impacted their consideration for intracranial stenting. Post-SAMMPRIS, 84% selected ‘SAMMPRIS-style’ medical management for the treatment of ICAD. For patients with ICAD who failed aggressive medical therapy, 82% would consider an alternative approach to continuing medical therapy (30% considered clinical trial enrollment, 28% suggested angioplasty and stenting and 24% angioplasty). The majority of participants (85%) were willing to randomize patients with symptomatic ICAD in future trials. For the next ICAD trial, 29% indicated that angioplasty alone should be compared with aggressive medical therapy.

Conclusions Our polling results suggest that the SAMMPRIS trial has had an impact on the current treatment of ICAD. Treatment of patients who failed medical therapy varied widely from aggressive medical therapy to balloon angioplasty, stenting or enrollment in future clinical trials. The willingness to continue clinical trials and randomize patients supports the need for future ICAD studies.

  • Angioplasty
  • Atherosclerosis
  • Intervention
  • Stroke
  • Stenosis
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