Intensive medical treatment more effective in preventing second stroke than stenting

People who received intensive medical treatment following a first stroke had fewer second episodes and were less likely to die than people who received brain stents in addition to medical treatment, according to a new report in the New England Journal of Medicine, to be published online Sept. 7. All patients in the study had experienced one stroke and were considered at high risk for a second one.

Two co-authors on the paper were Methodist Neurological Institute investigators involved in the NIH-funded trial - Dr. David Chiu, principal investigator and medical director of Methodist's Eddy Scurlock Stroke Center, and Dr. Richard Klucznik, co-investigator and interventional neuro-radiologist.

"This study is important because it will impact the way we treat stroke patients with arterial blockage in the brain," said Chiu. "Over the past several years, we have improved treatments for intracranial atherosclerosis, and this research shows that intensive medical management is the key to preventing stroke recurrence."

The Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study enrolled more than 450 patients at 50 sites across the United States

Co-authors say stroke patients with recent symptoms and intracranial arterial blockage of 70 percent or greater should be treated with an aggressive medical therapy that mirrors the regimen used in this trial. The regimen used in the study included daily blood-thinning medications and the aggressive control of blood pressure and cholesterol.

The Methodist Neurological Institute had the fourth largest patient enrollment nationwide (20). New enrollment in the study was stopped in April because early data showed significantly more strokes and deaths occurred among the stented patients at the 30-day mark compared to the group who received the medical management alone. All patients will continue to be followed for two years to determine the long term effects of both interventions.

In addition to the intensive medical program, half of the patients in the study received an intervention of a self-expanding stent called a Gateway-Wingspan that widens a major artery in the brain and facilitates blood flow. The study patients at Methodist who received a stent (10) suffered no complications from stenting.

"One possible explanation for the higher stroke rate in the overall stented group is that patients who have had recent stroke symptoms sometimes have unstable plaque in their arteries which the stent could have dislodged," said Dr. Richard Klucznik, interventional neuro-radiologist at Methodist and co-author on the paper.