Expanded abstract Citation Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, Janis LS, Lutsep HL, Barnwell SL, Waters MF, Hoh BL, Hourihane JM, Levy EI, Alexandrov AV, Harrigan MR, Chiu D, Klucznik RP, Clark JM, McDougall CG, Johnson MD, Pride GL Jr, Torbey MT, Zaidat OO, Rumboldt Z, Cloft HJ, for the SAMMPRIS Trial Investi- gators. N Engl J Med 2011, 365:993-1003. PubMed PMID: 21899409. his is available on www.pubmed.gov. Background Atherosclerotic intracranial arterial stenosis is an important cause of stroke that is increasingly 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. Methods Objective: To determine whether intracranial stenting (using the Wingspan self-expanding nitinol stent, Boston Scientific) and intensive medical therapy is superior to intensive medical therapy alone for preventing stroke in recently symptomatic patients with severe intracranial atherosclerotic stenosis. Design: Phase III, multi-center, randomized, open label, clinical trial. Setting: 50 sites in the US Subjects: Patients who had a recent transient ischemic attack or stroke attributed to stenosis of 70 to 99% of the diameter of a major intracranial artery. Intervention: Eligible patients were randomized to receive either aggressive medical medical management alone or aggressive medical management plus PTAS with the use of the Wingspan stent system. Outcomes: he primary end point was stroke or death within 30 days after enrollment or after a revasculari- zation procedure for the qualifying lesion during the follow-up period or stroke in the territory of the qualify- ing artery beyond 30 days. Patients in the medical arm who undergo angioplasty for recurrent TIAs (i.e. cross- overs) and who have a stroke or death within 30 days will also meet this endpoint. Results Of the 451 patients who underwent randomization, 227 were assigned to the medical management group and 224 to the PTAS group. he 30-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%; non–stroke-related death, 0.4%) (P = 0.002). Beyond 30 days, stroke in the same territory occurred in 13 patients in each group. he probability of the occurrence of a primary end-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 group and 12.2% in the medical-management group. Conclusions In patients with intracranial arterial stenosis, aggressive medical management was superior to PTAS with the use of the Wingspan stent system, both because the risk of early stroke after PTAS was high and because the risk of stroke with aggressive medical therapy alone was lower than expected. Commentary Stroke is a major public health problem as it is a leading cause of death and long-term disability in the United States. here are approximately 795,000 incident strokes each year, resulting in more than 140,000 deaths annually [1]. In 2010, the cost of stroke care was estimated at $74 billion, with a mean lifetime cost of $140,000 per patient [2]. Atherosclerotic disease of the major intracranial arteries is a frequent cause of ischemic stroke with annual risk as high as 24% [3]. Patients with severe intracranial © 2010 BioMed Central Ltd Stenting versus aggressive medical therapy for intracranial arterial stenosis: more harm than good Muthanna Al Hasan 1,2 and Raghavan Murugan* 1,2 University of Pittsburgh Department of Critical Care Medicine: Evidence-Based Medicine Journal Club, edited by Sachin Yende JOURNAL CLUB CRITIQUE *Correspondence: muruganr@upmc.edu 642A Scaife Hall, 3550 Terrace Street, University of Pittsburgh, Pittsburgh, PA 15261, USA Full list of author information is available at the end of the article Al Hasan and Murugan Critical Care 2012, 16:310 http://ccforum.com/content/16/3/310 © 2012 BioMed Central Ltd