The Challenges of Intracranial Revascularization for Stroke Prevention

The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial1 (SAMMPRIS, ClinicalTrials.gov number, NCT00576693), as reported by Chimowitz et al. in this issue of the Journal, showed that aggressive medical management alone was superior to intracranial arterial stenting with the use of the Wingspan stent system in addition to aggressive medical therapy in patients with a recent transient ischemic attack or stroke attributed to 70 to 99% stenosis of the diameter of a major intracranial artery. Three key lessons can be gleaned from the SAMMPRIS trial and previous trials of revascularization for stroke prevention: the challenges . . .