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Letter to the editor
Patient selection, physician experience and antiplatelet therapy testing are critical
  1. Michael J Alexander
  1. Correspondence to Dr Michael J Alexander, Department of Neurosurgery, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 800E, Los Angeles, CA 90048, USA

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The response1 from the principal investigators of the Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke (SAMMPRIS) trial2 is greatly appreciated. Healthy debate helps us weed out the details that are important in these studies and future trial design. Although the principal investigators label some of the editorial comments as ‘inaccuracies’, one could disagree based on the information listed below. Let us look at the numbers and facts.

First, they state that the SAMMPRIS population was the right population to test based on the Warfarin versus Aspirin for Symptomatic Intracranial Disease (WASID) trial data. However, they base this statement on the criteria of the degree of stenosis and some standard but relatively artificial epidemiological criteria, not focusing on some other important clinical criteria. For example, the mean time from the qualifying event to enrollment was 17 days in the WASID trial and 7 days in the SAMMPRIS trial, so these are not exactly the same patient populations. The patients who were stented in the SAMMPRIS …

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