Reviving Intracranial Angioplasty and Stenting “SAMMPRIS and beyond”

Abstract

We review the methods and results of Stenting and Aggressive Medical Management for Preventing Recurrent Stroke (SAMMPRIS) and provide a critical review of its strengths and limitations. In SAMMPRIS, the aggressive medical treatment arm (AMT arm) did substantially better than the Wingspan Stenting plus aggressive medical management arm (WS+ arm). Complications in the first 30 days post intervention led to the disparity between treatment arms. A major contribution of SAMMPRIS was the added value that AMT and lifestyle change may provide, when compared to a precursor trial, Warfarin–Aspirin Symptomatic Intracranial Disease (WASID), designed to prevent stroke in persons with high-grade symptomatic intracranial occlusive disease, however, the results of neither of these two trials have ever been reproduced. On the other hand, we argue that technical limitations of the Wingspan stent system (WS System) and lack of an angioplasty only intervention arm may have led to a premature launch of the trial and early termination of the study. Future randomized trials with different devices and modified patient selection criteria are warranted.

Current Status and Future Perspective of Stenting for Symptomatic Intracranial Atherosclerotic Disease: A Meta-Analysis

“…We thought that the pros and cons of these methods require a clear decision-making based on individual features. Effective exploration for PTAS is on the way forever, and the design of the studies should take imaging techniques, lesion features, stent type, different stages of ischemic stroke, and procedural techniques into consideration [ 26 , 27 ]. There are many different endovascular treatments such as angioplasty plus low radial force self-expanding stent, balloon-expandable drug-eluting stent, high radial force self-expanding stent without angioplasty, and drug-eluting balloon with low or high radial force self-expanding stent.…”

Intrajugular balloon catheter reduces air embolism in vitro and in vivo

“…In our prototype testing, we experienced a balloon prolapse to the contralateral site of the connecting orifice so that instant deflation was not possible. Although balloon catheters are well established devices for use in vascular angioplasty or during anaesthesia as pulmonary artery catheters, 31 32 the next step of prototype development will address such complications.…”

Do Study Results Translate Into Practice? Intracranial Stenting in Germany

“…Since its first publication in September 2011, the results of the SAMMPRIS study have been the subject of intense debate (9;10). The review by Farooq et al (10) concluded that over time, more effective and safer endovascular procedures may be developed and further trials would be needed to determine if these procedures with advanced technology lower the risk of stroke compared with aggressive medical therapy in high-risk subgroups.…”