Abstract 3517: Rate of Post-procedural Stroke and Death in SAMMPRIS Trial Eligible Patients Treated with Intracranial Angioplasty and/or Stent Placement in Practice

Object: To study the 30 day stroke and death rate in intracranial angioplasty and stent treated patients meeting Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial eligibility criteria. Background: SAMMPRIS trial, comparing aggressive medical versus stent treatment in patients with symptomatic intracranial stenosis, was halted after a 14% stroke and death rate observed in the stent treated group. Material and Methods: A retrospective analysis of 96 patients treated with intracranial angioplasty and stent placement at two University affiliated institutions was performed. Patients were divided into SAMMPRIS eligible and ineligible groups based on inclusion and exclusion criteria for SAMMPRIS trial. Results: Sixty-nine patients were determined to be SAMMPRIS eligible and 27 patients were ineligible. SAMMPRIS eligible group was divided into angioplasty and stent treated subgroups (30 and 39 patients, respectively). The overall 1 month post-procedure stroke and death rate was 7.2% (95%CI 2.3%-15.4%) in SAMMPRIS eligible group and 7.4% in SAMMPRIS ineligible group (p=0.97). The 1 month post-procedure stroke and death rate was 3.3% in the SAMMPRIS eligible angioplasty treated subgroup and 10.2% in the SAMMPRIS eligible stent treated subgroup (p=0.27). The SAMMPRIS eligible stent treated subgroup comprised of relatively younger patients compared to angioplasty treated subgroup (mean age of 58 versus 63 years, p=0.041). Lesion length was 6.4 ± 2.5 mm in SAMMPRIS eligible angioplasty and stent treated subgroups and 8.2 ± 3.7 in SAMMPRIS ineligible group (p=0.041). Conclusion: The overall 30 day post-procedure stroke and death rate in our study was lower in both SAMMPRIS eligible and ineligible than the reported 14% stroke and death in SAMMPRIS trial. We hypothesize that a more judicious use of primary angioplasty may be responsible for better post-procedural outcomes and should be considered as an acceptable treatment in future trials.