file:///C:/Documents%20and%20Settings/Edson/Meus%20documentos/Downloads/NEOPLASIAS%20DE%20NASOFARINGE.pdf T h e ne w e ngl a nd j our na l o f me dic i ne10.1056/nejmoa1105335 nejm.org 1original articleStenting versus Aggressive Medical Therapy for Intracranial Arterial StenosisMarc I. Chimowitz, M.B., Ch.B., Michael J. Lynn, M.S., Colin P. Derdeyn, M.D.,Tanya N. Turan, M.D., David Fiorella, M.D., Ph.D., Bethany F. Lane, R.N.,L. Scott Janis, Ph.D., Helmi L. Lutsep, M.D., Stanley L. Barnwell, M.D., Ph.D.,Michael F. Waters, M.D., Ph.D., Brian L. Hoh, M.D., J. Maurice Hourihane, M.D.,Elad I. Levy, M.D., Andrei V. Alexandrov, M.D., Mark R. Harrigan, M.D.,David Chiu, M.D., Richard P. Klucznik, M.D., Joni M. Clark, M.D.,Cameron G. McDougall, M.D., Mark D. Johnson, M.D., G. Lee Pride, Jr., M.D.,Michel T. Torbey, M.D., M.P.H., Osama O. Zaidat, M.D.,Zoran Rumboldt, M.D., and Harry J. Cloft, M.D., Ph.D.,for the SAMMPRIS Trial Investigators*The authors affiliations are listed in the Appendix. Address reprint requests to Dr. Chimowitz at the Medical University of SouthCarolina Stroke Program, 19 Hagood Ave.,Harborview Office Tower, Suite 501, Charleston, SC 29425, or at mchimow@musc.edu.*The investigators in the Stenting andAggressive Medical Management for Preventing Recurrent Stroke in IntracranialStenosis (SAMMPRIS) trial are listed inthe Supplementary Appendix, availableat NEJM.org.This article (10.1056/NEJMoa1105335) waspublished on September 7, 2011, at NEJM.org.N Engl J Med 2011.Copyright 2011 Massachusetts Medical Society.A bs tr ac tBackgroundAtherosclerotic intracranial arterial stenosis is an important cause of stroke that isincreasingly being treated with percutaneous transluminal angioplasty and stenting(PTAS) to prevent recurrent stroke. However, PTAS has not been compared with medical management in a randomized trial.MethodsWe randomly assigned patients who had a recent transient ischemic attack or strokeattributed to stenosis of 70 to 99% of the diameter of a major intracranial artery toaggressive medical management alone or aggressive medical management plus PTASwith the use of the Wingspan stent system. The primary end point was stroke ordeath within 30 days after enrollment or after a revascularization procedure for thequalifying lesion during the follow-up period or stroke in the territory of the qualifying artery beyond 30 days.ResultsEnrollment was stopped after 451 patients underwent randomization, because the30-day rate of stroke or death was 14.7% in the PTAS group (nonfatal stroke, 12.5%;fatal stroke, 2.2%) and 5.8% in the medical-management group (nonfatal stroke, 5.3%;nonstroke-related death, 0.4%) (P=0.002). Beyond 30 days, stroke in the same territory occurred in 13 patients in each group. Currently, the mean duration of followup, which is ongoing, is 11.9 months. The probability of the occurrence of a primaryend-point event over time differed significantly between the two treatment groups(P=0.009), with 1-year rates of the primary end point of 20.0% in the PTAS groupand 12.2% in the medical-management group.ConclusionsIn patients with intracranial arterial stenosis, aggressive medical management wassuperior to PTAS with the use of the Wingspan stent system, both because the riskof early stroke after PTAS was high and because the risk of stroke with aggressivemedical therapy alone was lower than expected. (Funded by the National Institute ofNeurological Disorders and Stroke and others; SAMMPRIS ClinicalTrials.gov number, NCT00576693.)The New England Journal of MedicineDownloaded from nejm.org by Edson Missugiro on September 8, 2011. For personal use only. No other uses without permission. Copyright 2011 Massachusetts Medical Society. All rights