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Percutaneous Transluminal Angioplasty and Stenting (PTAS) – Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis

Posted in Bio Instrumentation in Experimental Life Sciences Research, Frontiers in Cardiology and Cardiovascular Disorders, Medical Devices R&D and Inventions, Origins of Cardiovascular Disease, Stents & Tools, Uncategorized, tagged Angioplasty, Artery, Atherosclerosis, Intracranial arterial stenosis, New England Journal Medicine, Stent, Stroke on July 5, 2012| 1 Comment »

Percutaneous Transluminal Angioplasty and Stenting (PTAS) – Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis

Reporter: Aviva Lev-Ari, PhD, RN

RESULTS

Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (Original Article, N Engl J Med 2011 ; 365 : 993 – 1003) . In the first paragraph of Results (page 996), the penultimate sentence should have read, “Of the 224 patients in the PTAS group, 16 (7.1%) did not have a stent placed (the procedure was not performed in 4 patients, the procedure was aborted before the lesion was accessed in 7, and angioplasty alone was performed in 5),”

http://www.nejm.org/doi/full/10.1056/NEJMx120039?query=TOC

BACKGROUND

Atherosclerotic intracranial arterial stenosis is an important cause of stroke that is increasingly being treated with percutaneous transluminal angioplasty and stenting (PTAS) to prevent recurrent stroke. However, PTAS has not been compared with medical management in a randomized trial.

METHODS

We randomly assigned patients who had a recent transient ischemic attack or stroke attributed to stenosis of 70 to 99% of the diameter of a major intracranial artery to aggressive medical management alone or aggressive medical management plus PTAS with the use of the Wingspan stent system. The primary end point was stroke or death within 30 days after enrollment or after a revascularization procedure for the qualifying lesion during the follow-up period or stroke in the territory of the qualifying artery beyond 30 days.

CONCLUSIONS

In patients with intracranial arterial stenosis, aggressive medical management was superior to PTAS with the use of the Wingspan stent system, both because the risk of early stroke after PTAS was high and because the risk of stroke with aggressive medical therapy alone was lower than expected.

http://www.nejm.org/doi/full/10.1056/nejmoa1105335