Stenting Inferior to Aggressive Medical Management in Stroke

Medical therapy alone superior at preventing stroke in patients with intracranial arterial stenosis

WEDNESDAY, Sept. 7 (HealthDay News) -- Medical management alone is better at preventing recurrent stroke for patients with intracranial arterial stenosis than in combination with percutaneous transluminal angioplasty and stenting (PTAS), according to a study published online Sept. 7 in the New England Journal of Medicine.

Marc I. Chimowitz, M.B., Ch.B., from the Medical University of South Carolina in Charleston, and colleagues compared the combination of PTAS (Wingspan stent system) with medical management to medical management alone in patients with recent transient ischemic attack or stroke (70 to 99 percent stenosis). The primary end point was stroke or death within 30 days after enrollment or after a revascularization procedure during 11.9 months of follow-up, or a stroke in the territory of the qualifying artery beyond 30 days.

The investigators found that enrollment ceased after 451 patients, as the PTAS and medical-management alone groups had a 30-day rate of stroke or death of 14.7 and 5.8 percent, respectively. Non-fatal and fatal strokes were seen in 12.5 and 2.2 percent of those in the PTAS group, respectively, and in 5.3 and 0.4 percent of those in the medical management alone group, respectively. In each group, stroke recurred in the same territory in 13 patients after the 30-day period. The two groups had significantly different one-year primary end point rates of 20.0 percent in the PTAS group and 12.2 percent in the medical-management group.

"In patients with intracranial arterial stenosis, aggressive medical management was superior to PTAS with the use of the Wingspan stent system," the authors write.

The study was supported by AstraZeneca, Stryker Neurovascular (formerly Boston Scientific Neurovascular), Nationwide Better Health-INTERVENT, Walgreens pharmacies, and the San Diego Center for Health Interventions.

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