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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Arterial Stenosis trial [SAMMPRIS; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00576693\u0026amp;atom=%2Fspmdc%2F12%2F1%2F13.atom\u0022\u003ENCT00576693\u003C\/a\u003E] found that treatment with aggressive medical management (AMM) was superior to AMM plus percutaneous transluminal angioplasty and stenting [Chimowitz MI et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011]. This article presents a detailed analysis of 30-day outcomes from the stenting arm of the SAMMPRIS trial.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Radiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ESymptomatic intracranial stenoses are an important cause of stroke, which has a high risk of recurrence with medical therapy [Chimowitz MI et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2005]. Yet, the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Arterial Stenosis trial [SAMMPRIS; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00576693\u0026amp;atom=%2Fspmdc%2F12%2F1%2F13.atom\u0022\u003ENCT00576693\u003C\/a\u003E] found that treatment with aggressive medical management (AMM) was superior to AMM plus percutaneous transluminal angioplasty and stenting (PTAS) [Chimowitz MI et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011]. Colin Derdeyn, MD, FAHA, Washington University School of Medicine, St. Louis, Missouri, USA, presented a detailed analysis of 30-day outcomes from the stenting arm of the SAMMPRIS trial.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe number of patients who underwent angioplasty\/stenting was 213. Post hoc analyses were all bivariate, without Bonferroni correction for multiple comparisons, and event rates were small. A total of 60 variables were used in the analysis.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAt 30 days, there were 7 parenchymal brain hemorrhages, one of which was asymptomatic, and 6 subarachnoid hemorrhages (SAH), one of which was asymptomatic; the others were caused by wire perforation or vessel rupture.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPostprocedure timing of intraparenchymal hemorrhage (IPH; n=7) ranged from immediate to 3 days. One case was symptomatic immediately postprocedure; 4 occurred within 4 to 24 hours; one occurred 2 days after the procedure; and another occurred at 3 days. All were distributed within the vascular territory of the targeted artery and were most likely secondary to reperfusion.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe interval between the qualifying event and PTAS ranged from 3 to 32 days. Outcomes were typically severe; 4 were fatal; one had an mRS score of 5 and another had 2; and one was asymptomatic. Significant and select factors for IPH included baseline percent of stenosis (central; p=0.011); preangiography diameter stenosis (DS; mm; p=0.01); JPEG review (p=0.042); and preangiography DS (mm; p=0.058). This suggests a common theme of small vessel diameter as a risk factor for IPH after stenting.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ESix patients had periprocedural subarachnoid hemorrhages. All were recognized during or immediately after the procedure. Three were most likely guidewire perforations or vessel rupture. Obvious perforation was controlled with coil or glue occlusion of the vessel (n=2).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ETwo suspected cases of occult perforation were confirmed with CT imaging during or immediately after the procedure; one was asymptomatic, and the other was related to wire perforation.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ESignificant factors for wire perforation included stent diameter (p=0.051), preangiography percent stenosis (local; p=0.012), and max balloon inflation time (sec; p=0.005). These factors suggest that small vessel diameter predisposes one to SAH after stenting.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EIschemic complications in treated lesions included 12 local perforator distributions, 5 embolic strokes, and 2 delayed stent occlusions that occurred at 4 and 6 days. Both complications resulted in large ipsilateral strokes.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003ESignificant and other select factors for ischemic strokes (n=19) included having diabetes (p=0.017), mean age (p=0.024), and symptomatic artery (p=0.059). For procedural perforator strokes, significant factors included lesion length (p=0.075), mean age (p=0.072), and symptomatic artery (p=0.017). For procedural embolic strokes (n=5), they included serum glucose (p=0.058), baseline stenosis percentage (local; p=0.096), and baseline Dn (local) mm (p=0.076). Most procedure-related ischemic strokes were local perforator territory and most were in the basilar artery.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EPeriprocedural primary event rate as a function of wingspan volume is shown in \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E. Thirty-day primary endpoint rates at sites with the most experience in registries and in SAMMPRIS are shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E. Interventionists that came into the trial with less wingspan experience did not have higher rates of 30-day primary endpoints than those with more experience. These data suggest that the credentialing process selects physicians with good technical expertise.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12711\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12711\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12711\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003EThirty-Day Primary Endpoint Rates at Sites With The Most Experience in Registries and in SAMMPRIS.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/1\/13\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Operator Wingspan Credentialing Volume.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1124236594\u0022 data-figure-caption=\u0022Operator Wingspan Credentialing Volume.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/1\/13\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/1\/13\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/1\/13\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12710\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EOperator Wingspan Credentialing Volume.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from C. Derdeyn, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-16\u0022\u003EDr. Derdeyn concluded that angioplasty and stenting in a SAMMPRIS-eligible population carries high risk, owing to increased hemorrhage risk in smaller diameter vessels and increased ischemic stroke risk in perforator-rich vessel segments. Unfortunately, most symptomatic intracranial stenoses involve either small-diameter vessels or perforator-rich vessel segments. The relative lack of experience with the wingspan device was not a factor in the outcomes in the stenting arm of the trial.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/1\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzniod\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzniod\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzniod\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}