Stenting upstairs

File:Lateral head angiogram.jpg


Of the three big macrovascular diseases – peripheral vascular disease, cardiovascular disease, and cerebrovascular, the former two have been heavily involved with intervention, where the latter has been more of an area of medical management (intracranially; not including the carotids). So, how does stenting upstairs work out?



Intracranial stenting has been done for quite some years now, particularly for those patients who have had events while on antithrombotic events. The SAMMPRIS study began in 2008 to compare stenting with aggressive medical therapy – and had to be stopped early because of adverse events in the stenting group. 


Aggressive medical therapy consisted of aspirin, clopidogrel, management of hypertension (aiming a systolic of <140, using one drug from each class) and LDL (aiming less than 1.8, using rosuvastatin), as well as a lifestyle modification program. The intracranial stenting group got all that plus a Gateway balloon, followed by a Wingspan stent.


The primary end point was stroke or death at 30 days after enrolment or after a revascularisation procedure, with 14.7% in the stenting group and 5.8% in the medical therapy group – a worrying statistic. 


So, medical therapy is better and safer, particularly with the high periprocedural events with the stenting system. Don’t forget – aspirin, clopidogrel, blood pressure modification, and drop that LDL, and you’re well on your way to preventing further events.


Check out the full article here




VIA NEJM
IMAGE Patrick J Lynch, via Wikimedia Commons





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