Stroke or TIA: intracranial stent reduces arterial blockage in the short term


A preliminary study funded by the National Institutes of Health ( NIH ) found that a stent designed to open clogged arteries in the brain was successfully deployed in nearly all cases and significantly reduced arterial blockage in the short term. But data on the long-term benefit of the stent, compared to medical treatment alone, were inconclusive, prompting the upcoming launch of a large-scale randomized trial that is expected to provide definitive results.

The NIH Wingspan Registry collected statistics on 129 patients who had an intracranial artery narrowed by at least 70 percent and were experiencing recurrent strokes or transient ischemic attacks ( TIAs ) despite being on anti-clotting medication. Treatment included use of the Wingspan intracranial stent developed by Boston Scientific.
Seven centers in the United States participated in the trial, and results are published in the journal Neurology.

“ Treatment options for stroke patients with severe blockages are extremely limited. As opposed to the situation in blocked heart arteries where options include angioplasty, stenting and surgical bypass, there is no surgical option for these blockages in the brain. This stent may be a major advance for patients with high-grade stenosis who have a stroke or TIA. Previously they could just take medication and expect to have a high recurrent stroke rate, ” said neurosurgeon Michael J. Alexander, one of the article’s authors and director of the Cedars-Sinai Neurovascular Center. Before coming to Cedars-Sinai Medical Center in 2007, Alexander was founder and director of the Neurovascular Center at Duke University, where he was one of the Wingspan study leaders.

The Wingspan trial followed another NIH-funded study comparing two blood-thinning medications commonly used to treat narrowing of intracranial arteries.
The Warfarin-Aspirin Symptomatic Intracranial Disease Study ( WASID ) found that Warfarin ( Coumadin ) and Acetylsalicylic acid ( Aspirin ) provided similar stroke protection, but Aspirin was associated with a lower risk of hemorrhage and related complications.

The WASID study also found that a patient who recently had a stroke or TIA and suffered a cranial artery blockage of 70 percent or higher had a 22 percent chance of having another stroke within the first year, regardless of which medication was used. While the objective of the WASID trial was to compare the two drugs, results of the medication study provide a baseline against which other therapies can be compared.

“ We know that patients with 70 percent to 99 percent stenosis and TIA or stroke within the previous 30 days are at highest risk of having another stroke, ” Alexander said. “ These are the patients who have the most to gain from stenting and are the ones we will target for enrollment in the randomized trial of stenting versus medical therapy.”

Source: Cedars-Sinai Medical Center, 2008

XagenaMedicine_2008



Indietro

Altri articoli

Venous percutaneous transluminal angioplasty ( vPTA ) in patients with multiple sclerosis ( MS ) and chronic cerebrospinal venous insufficiency...


Two separate clinical trials were presented as a part of ACC.15, and looked at strategies to reduce major bleeding and...


The FDA ( Food and Drug Administration ) has cleared for marketing the ENROUTE Transcarotid Neuroprotection System ( ENROUTE TNS...


Silent infarction in the brain can be detected in around 34% of patients after carotid endarterectomy ( CEA ) and...


Early results of the SAMMPRIS ( Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis ) trial...


Clinical equipoise of carotid revascularization therapies remains controversial. Researchers sought to determine whether adverse outcomes after carotid endarterectomy ( CEA...


The European Medicines Agency ( EMA ), the Committee for Medicinal Products for Human Use ( CHMP ), and the...


The aim of a study was to compare the efficacy of revascularization versus medical therapy in patients with atherosclerotic renal...


Women suffer more disabling strokes than men and need to become better aware of their unique risk factors, according to...


The Resolute Integrity stent is a metal stent with the drug Zotarolimus contained in a thin coating on the stent’s...