Current status of the management of symptomatic intracranial atherosclerotic disease: the rationale for a randomized trial of medical therapy and intracranial stenting.

Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) is a randomized trial comparing aggressive medical management alone with aggressive medical management in combination with angioplasty and stenting using the Gateway-Wingspan system in patients with symptomatic, high-grade, intracranial stenosis. This trial represents a landmark in the maturation of the field of neurointervention, establishing a foundation for evidenced-based practice. We review the natural history of symptomatic intracranial stenosis when treated medically, the available interventional therapies and the rationale for the design of the SAMMPRIS trial.