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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\u003EAs landmark trials have shown no outcome improvement with vascular bypass or percutaneous angioplasty and stenting, aggressive medical management remains the gold standard for symptomatic intracranial artery disease [Augoustides JG. \u003Cem\u003EJ Cardiothorac Vasc Anesth\u003C\/em\u003E 2012]. This article presented outcomes of patients in the SAMMPRIS trial who had failed antithrombotic therapy at study enrollment.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAs landmark trials have shown no outcome improvement with vascular bypass or percutaneous angioplasty and stenting, aggressive medical management (AMM) remains the gold standard for symptomatic intracranial artery disease [Augoustides JG. \u003Cem\u003EJ Cardiothorac Vasc Anesth\u003C\/em\u003E 2012]. Helmi L. Lutsep, MD, FAHA, Oregon Health \u0026amp; Science University, Portland, Oregon, USA, presented outcomes of patients in the SAMMPRIS trial who had failed antithrombotic therapy at study enrollment.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe analysis compared AMM and percutaneous transluminal angioplasty and stenting (PTAS) in group-on and group-off antithrombotic therapy at the qualifying event. The primary endpoints were stroke and death at 30 days or stroke in the territory of the qualifying artery beyond 30 days.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EData showed that 63% of SAMMPRIS patients (284\/451) had their qualifying events while on antithrombotic therapy; 140 were randomized to AMM, and 144 were randomized to PTAS. Thirty-seven percent of patients (167\/451) were not on antithrombotic therapy; 87 were randomized to AMM, and 80 were randomized to PTAS. Of the 284 patients who had a qualifying event on antithrombotics, 95.8% were on antiplatelet therapy only (clopidogrel+aspirin; 22.5%), 1.4% were taking anticoagulants only, and 2.8% were on both antiplatelet and anticoagulant therapy.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe patient characteristics were different in the group with a qualifying event on antithrombotic therapy compared with the group that was off of antithrombotic therapy. The group that had been on antithrombotic therapy at the time of the qualifying event was older and had a longer history of hypertension, lipid disorders, coronary artery disease, and stroke prior to the qualifying event. In this group, the qualifying event was also more often a stroke rather than a transient ischemic attack, and the symptomatic artery differed, more commonly involving a vertebral or basilar artery.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EBaseline measures of risk factors between the two groups were similar, except that glycated hemoglobin in diabetics was lower in the antithrombotic therapy group (p=0.03). In terms of concomitant medication at the time of study entry, only beta-blockers and nonstatin lipid-lowering medications were different between the group-on (119\/284, 42%; 58\/284, 20%) and group-off (53\/167, 32%; 19\/167, 11%) participants (p=0.0319 and p=0.0137, respectively).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe percentage of group-on patients who were on AMM (n=140) who reached the primary endpoint was 12.1%; in the PTAS group (n=144), the primary endpoint was reached by 21.5% of patients. At 30 days, the primary endpoint rates were 4.3% versus 16.0%, respectively; after 30 days, they were 7.9% versus 5.6%, respectively.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EAmong those who were on antithrombotic therapy with a qualifying event, the cumulative probability of a primary endpoint occurring at 15 months of follow-up was significantly higher in the PTAS group than the AMM group (p=0.028 overall; p=0.0009 at 30 days; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Among those who were on antithrombotic therapy and had a history of ischemic stroke with a qualifying event, the difference in the primary endpoint between the AMM (n=49) and PTAS group (n=51) was 14.3% versus 35.3%, respectively. At 30 days, the respective numbers were 8.2% versus 25.5%, and after 30 days, they were 6.1% versus 9.8% (p=0.014 overall; p=0.019 at 30 days).\u003C\/p\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\/14\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Qualifying Event On Antithrombotic Therapy.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-481661460\u0022 data-figure-caption=\u0022Qualifying Event On Antithrombotic Therapy.\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\/14\/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\/14\/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\/14\/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\/12712\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-9\u0022 class=\u0022first-child\u0022\u003EQualifying Event On Antithrombotic Therapy.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from HL Lutsep.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EThere was no significant difference between the AMM and PTAS groups that had a qualifying event while not on antithrombotic therapy (p=0.14 overall; p=0.35 at 30 days; \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). No significant difference was observed between those patients who were treated with AMM who were either on or off antithrombotics at the time of their qualifying event.\u003C\/p\u003E\u003Cdiv id=\u0022F2\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\/14\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Qualifying Event Not On Antithrombotic Therapy.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-481661460\u0022 data-figure-caption=\u0022Qualifying Event Not On Antithrombotic Therapy.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/1\/14\/F2.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\/14\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\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\/14\/F2.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\/12713\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 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003EQualifying Event Not On Antithrombotic Therapy.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from HL Lutsep.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-12\u0022\u003EThe authors pointed out that those patients who had been on antithrombotics had a greater number of risk factors and that those patients with intracranial stenosis had more benefit from AMM than PTAS with the Wingspan stent system, even if they had failed antithrombotic therapy.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EThe benefit of AMM is similar in patients who are on versus off antithrombotic medication at the time of their qualifying events. These findings support those from the Warfarin Aspirin Symptomatic Intracranial Disease (WASID) trial, showing that antithrombotic therapy failure does not identify a higher-risk subgroup of patients with intracranial stenosis [Chimowitz MI et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2005].\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\/14.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\u003C\/body\u003E\u003C\/html\u003E"}