Monday, April 14, 2014

Treatment Trends In Management Of Intracranial Stenosis In The Pre- And Post-Sammpris Era (I8-1.008)

Treatment Trends In Management Of Intracranial Stenosis In The Pre- And Post-Sammpris Era (I8-1.008)
Neurology recent issues

BACKGROUND: Treatment of intracranial stenosis has evolved over the course of the last 2 decades. This survey sought to define the impact of, 'Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS)' an NIH-sponsored clinical trial on treatment trends of physicians in managing intracranial stenosis.METHODS: Surveys of treatment choices were sent 1 year post-publication of the SAMMPRIS Trial results. (2012). A similar survey designed in the Post- Warfarin Vs. Aspirin for Symptomatic Intracranial Disease (WASID) Trial Era, another NIH-sponsored clinical trial was used to compare treatment trends (pre-SAMMPRIS survey). Both the surveys were sent to neurologists as well as neurointerventionists. The post-SAMMPRIS survey addressed questions regarding the maximum benefit physicians would require to recommend a new endovascular treatment to their patients. Data was analyzed using the chi-square tests.RESULTS: Post-SAMMPRIS, the number of respondents recommending antiplatelet treatment for intracranial stenosis increased. Compared to the post-WASID/pre-SAMMPRIS respondents, more post-SAMMPRIS respondents preferred antiplatelet agents for stenosis in the anterior circulation (85% vs. 94%, p=0.0017) and posterior circulation (74% vs. 83%, p=0.0145). The antiplatelet agent most post-SAMMPRIS was the combination of aspirin and clopidogrel. The percentage of neurologists who recommended percutaneous transluminal angioplasty and stenting (PTAS) in > 25% of ICAS patients decreased from pre-SAMMPRIS (12%) to post-SAMMPRIS (6%), while for neurointerventionists, it decreased from (49%) to (17%).DISCUSSION: SAMMPRIS had a major impact on treatment trends of physicians managing patients with intracranial stenosis. In the Post-SAMMPRIS survey, 91% of respondents participating in SAMMPRIS and 82% of overall respondents indicated that the SAMMPRIS results changed the way they managed patients with ICAS.As aggressive medical management coupled with optimal risk factor reduction shows promise in reducing rates of recurrent stroke, a novel endovascular therapy will have to seek newer heights of increasing RRR to gain acceptance by practitioners.

Disclosure: Dr. Pawar has nothing to disclose. Dr. Turan has received personal compensation for activities with Gore Laboratories Inc., and Boehringer Ingelheim Pharmaceuticals Inc. Dr. Turan has received research support from Stryker Co., the National Institutes of Health, and AstraZeneca. Dr. Cotsonis has nothing to disclose. Dr. Lynn has nothing to disclose. Dr. Wooley has nothing to disclose. Dr. Stern has received personal compensation for activities with Lippincott Williams & Wilkins. Dr. Stern has received personal compensation in an editorial capacity for The Neurologist. Dr. Derdeyn has received personal compensation for activities with W.L. Gore and Associates, Boston Scientific Corporation, and Target Therapeutics. Dr. Fiorella has received personal compensation for activities with Covidien/ev3, Codman/Micrus/JNJ, NFocus, Vascular Simulations, CSVL, Microvention/Terumo, and Siemens Medical Imaging. Dr. FIorella has received royalty, or license fee, or contractual rights payments from Codman/Micrus/JNJ. Dr. Fiorella has received research support from Microvention and Siemens Medical Imaging. Dr. Chimowitz has received personal compensation for activities with Axio Research, Merck & Co. Inc., and Gore. Dr. Chimowitz has received research support from the National Institute of Neurological Disorders and Stroke, Stryker, and Boston Scientific Corporation.



Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/I8-1.008?rss=1

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