Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis

被引：1434

作者：

Chimowitz, Marc I. ^{[1
]}

Lynn, Michael J. ^{[3
]}

Derdeyn, Colin P. ^{[4
,5
,6
]}

Turan, Tanya N.

Fiorella, David ^{[7
]}

Lane, Bethany F. ^{[3
]}

Janis, L. Scott ^{[8
]}

Lutsep, Helmi L. ^{[9
]}

Barnwell, Stanley L. ^{[10
,11
]}

Waters, Michael F. ^{[12
]}

Hoh, Brian L. ^{[13
]}

Hourihane, J. Maurice ^{[14
]}

Levy, Elad I. ^{[15
]}

Alexandrov, Andrei V. ^{[16
]}

Harrigan, Mark R. ^{[17
]}

Chiu, David ^{[18
]}

Klucznik, Richard P. ^{[19
]}

Clark, Joni M. ^{[20
]}

McDougall, Cameron G. ^{[21
]}

Johnson, Mark D. ^{[22
,23
]}

Pride, G. Lee, Jr. ^{[24
,25
]}

Torbey, Michel T. ^{[26
]}

Zaidat, Osama O. ^{[26
,27
,28
]}

Rumboldt, Zoran ^{[2
]}

Cloft, Harry J. ^{[29
]}

机构：

[1] Med Univ S Carolina, Stroke Program, Dept Neurosci, Charleston, SC 29425 USA

[2] Med Univ S Carolina, Dept Radiol, Charleston, SC 29425 USA

[3] Emory Univ, Rollins Sch Publ Hlth, Dept Biostat & Bioinformat, Atlanta, GA 30322 USA

[4] Washington Univ, Sch Med, Mallinckrodt Inst Radiol, St Louis, MO USA

[5] Washington Univ, Sch Med, Dept Neurol, St Louis, MO 63110 USA

[6] Washington Univ, Sch Med, Dept Neurosurg, St Louis, MO USA

[7] SUNY Stony Brook, Dept Neurosurg, Stony Brook, NY 11794 USA

[8] NINDS, NIH, Bethesda, MD 20892 USA

[9] Oregon Hlth & Sci Univ, Dept Neurol, Portland, OR 97201 USA

[10] Oregon Hlth & Sci Univ, Dept Neurol Surg, Portland, OR 97201 USA

[11] Oregon Hlth & Sci Univ, Dotter Intervent Inst, Portland, OR 97201 USA

[12] Univ Florida, Dept Neurol & Neurosci, Gainesville, FL USA

[13] Univ Florida, Dept Neurosurg, Gainesville, FL USA

[14] Dent Neurol Inst, Buffalo, NY USA

[15] SUNY Buffalo, Dept Neurosurg, Buffalo, NY 14260 USA

[16] Univ Alabama Birmingham, Dept Neurol, Birmingham, AL 35294 USA

[17] Univ Alabama Birmingham, Dept Neurosurg, Birmingham, AL USA

[18] Methodist Hosp, Dept Neurol, Houston, TX 77030 USA

[19] Methodist Hosp, Dept Radiol, Houston, TX 77030 USA

[20] Barrow Neurol Inst, Dept Neurol, Phoenix, AZ 85013 USA

[21] Barrow Neurol Inst, Dept Neurosurg, Phoenix, AZ 85013 USA

[22] Univ Texas SW Med Ctr Dallas, Dept Neurol, Dallas, TX 75390 USA

[23] Univ Texas SW Med Ctr Dallas, Dept Neurotherapeut, Dallas, TX 75390 USA

[24] Univ Texas SW Med Ctr Dallas, Dept Radiol, Dallas, TX 75390 USA

[25] Univ Texas SW Med Ctr Dallas, Dept Neurosurg, Dallas, TX 75390 USA

[26] Med Coll Wisconsin, Dept Neurol, Milwaukee, WI 53226 USA

[27] Med Coll Wisconsin, Dept Radiol, Milwaukee, WI 53226 USA

[28] Med Coll Wisconsin, Dept Neurosurg, Milwaukee, WI 53226 USA

[29] Mayo Clin, Dept Radiol, Rochester, MN USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2011年 / 365卷 / 11期

基金：

美国国家卫生研究院;

关键词：

ISCHEMIC-STROKE; RECURRENT STROKE; WINGSPAN STENT; PATTERNS; DISEASE; RISK; ATHEROSCLEROSIS; ANGIOPLASTY; PREDICTORS; RESTENOSIS;

D O I：

10.1056/NEJMoa1105335

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 We randomly assigned 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 to aggressive medical management alone or aggressive medical management plus PTAS with the use of the Wingspan stent system. The primary end point was stroke or death within 30 days after enrollment or after a revascularization procedure for the qualifying lesion during the follow-up period or stroke in the territory of the qualifying artery beyond 30 days. Results Enrollment was stopped after 451 patients underwent randomization, because the 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. Currently, the mean duration of follow-up, which is ongoing, is 11.9 months. The 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. (Funded by the National Institute of Neurological Disorders and Stroke and others; SAMMPRIS ClinicalTrials.gov number, NCT00576693.)

引用

页码：993 / 1003

页数：11

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