Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
Neurosurgery. 2012 Jul;71(1):68-73. doi: 10.1227/NEU.0b013e3182518575.
The SAMMPRIS (Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) trial, comparing aggressive medical vs stent treatment in patients with symptomatic intracranial stenosis, was halted after a 14% stroke and death rate was observed in the stent-treated group.
To study the 30-day stroke and death rate in intracranial angioplasty- and stent-treated patients meeting SAMMPRIS trial eligibility criteria.
A retrospective analysis of 96 patients treated with intracranial angioplasty and stent placement at 3 university-affiliated institutions was performed. Patients were divided into SAMMPRIS trial eligible and ineligible groups based on inclusion and exclusion criteria for the SAMMPRIS trial.
Sixty-nine patients were determined to be SAMMPRIS eligible and 27 patients were ineligible. The SAMMPRIS-eligible group was divided into angioplasty- and stent-treated subgroups (30 and 39 patients, respectively). The overall 30-day postprocedure stroke and death rate was 7.2% in the SAMMPRIS-eligible group and 7.4% in the SAMMPRIS-ineligible group (P = .97). The 30-day postprocedure stroke and death rate was 3.3% in the SAMMPRIS-eligible, angioplasty-treated subgroup and 10.2% in the SAMMPRIS-eligible, stent-treated subgroup (P = .27).
The overall 30-day postprocedure stroke and death rate in our study was lower in both SAMMPRIS-eligible and -ineligible groups than the reported 14% stroke and death rate in the SAMMPRIS trial. We hypothesize that a more judicious use of primary angioplasty may be responsible for better postprocedure outcomes and should be considered an acceptable treatment in future trials.
SAMMPRIS（支架置入与强化药物治疗预防颅内狭窄再发卒中）试验比较了症状性颅内狭窄患者的强化药物治疗与支架治疗，在支架治疗组观察到 14%的卒中和死亡率后被终止。
研究符合 SAMMPRIS 试验入选标准的颅内血管成形术和支架治疗患者的 30 天卒中和死亡率。
对 3 所大学附属医院的 96 例行颅内血管成形术和支架置入的患者进行回顾性分析。根据 SAMMPRIS 试验的纳入和排除标准，将患者分为符合和不符合 SAMMPRIS 试验的两组。
69 例患者被确定为符合 SAMMPRIS 试验标准，27 例患者不符合。SAMMPRIS 试验符合标准的患者分为血管成形术和支架治疗亚组（分别为 30 例和 39 例）。SAMMPRIS 试验符合标准组的总体 30 天术后卒中和死亡率为 7.2%，SAMMPRIS 试验不符合标准组为 7.4%（P =.97）。SAMMPRIS 试验符合标准、血管成形术治疗亚组的 30 天术后卒中和死亡率为 3.3%，SAMMPRIS 试验符合标准、支架治疗亚组为 10.2%（P =.27）。
我们的研究中，符合和不符合 SAMMPRIS 试验标准的两组的总体 30 天术后卒中和死亡率均低于 SAMMPRIS 试验报告的 14%的卒中和死亡率。我们推测，更谨慎地使用直接血管成形术可能是导致术后结果更好的原因，在未来的试验中应考虑将其作为一种可接受的治疗方法。
