To Stent or Not To Stent? The SAMMPRIS trial

One of the major controversies in stroke medicine is whether or not it is safe to apply a device (stent) to re-open areries in the brain which have become closed due to atherosclerosis and other disease processes. The issue is both safety and efficacy, as most people who can benefit from such a procedure have just suffered a stroke and are at serious risk of suffering a more devastating, even deadly one. So an important question to be answered is: do the benefits of stenting (re-opening the artery, improvement of serious stroke deficits, better blood flow to the brain, and sometimes, survival) outweigh its risks (bleeding, infection, but some times, death)?

The answer is being generated as we speak by stroke investigators in several sites thorughout the country who are carrying out the SAMMPRIS (Stenting vs Aggressive Medical Management for the Prevention of Recurrent Stroke) trial, which randomizes patients to either intracranial stenting (using the Wingspan self-expanding nitinol stent) or intensive medical therapy. Patients can be enrolled in the study for up to 30 days after a stroke in the area supplied by a narrow (70-99% stenosis) artery or intensive medical therapy which consists of aspirin 325 and Plavix for 90 days after stroke, followed by life-long aspirin thereafter. People who get stent will also receive medical therapy after the stent. The researchers hope to prove that intracranial stenting combined with intensive medical therapy is superior to intensive medical therapy alone.

Recommended reading:

Aspirin, Plavix, Side Effects
Deadly Strokes
Stroke Treatments