6/29/23, 11:41 PM SAMMPRIS Pathway Feedback Search Clinical Topics Home Studies SAMMPRIS SAMMPRIS Disease Disease Acute ischemic stroke Transient ischemic attack Trial question What is the role of aggressive medical treatment in high-risk patients with intracranial artery stenosis? Study design Multi-center Open label RCT Population Characteristics of study participants 40.0% female N = 451 60.0% male 451 patients (179 female, 272 male) Inclusion criteria: patients with recent TIA or stroke related to 70-99% stenosis of a major intracranial artery Key exclusion criteria: tandem extracranial or intracranial stenosis proximal or distal to the target intracranial stenosis, intraluminal thrombus proximal to or at the target lesion, progressive neurological signs within 24 h before enrolment, any hemorrhagic infarct within 14 days before enrolment, non-atherosclerotic causes of intracranial stenosis, and the presence of a cardiac source of embolus Interventions https://web.pathway.md/studies/recih0Oi2meGPX9cf 1/3 6/29/23, 11:41 PM SAMMPRIS Pathway N=227 aggressive medical management (antiplatelet therapy, intensive management of vascular risk factors, and a lifestyle modification program) N=224 percutaneous transluminal angioplasty and stenting (with Wingspan stent, plus aggressive medical management) Primary outcome Rate of stroke or death within 30 days after enrolment, ischemic stroke in the territory of the qualifying artery beyond 30 days of enrolment, or any stroke or death within 30 days after a revascularization procedure of the qualifying lesion during follow-up 14.7 % 14.7 11.0 % 7.3 % Significant decrease 5.8 3.7 % NNT = 11 0.0 % Aggressive medical management Percutaneous transluminal angioplasty and stenting Significant decrease in the rate of stroke or death within 30 days after enrolment, ischemic stroke in the territory of the qualifying artery beyond 30 days of enrolment, or any stroke or death within 30 days after a revascularization procedure of the qualifying lesion during follow-up (5.8% vs. 14.7%; ARD -8.9, 95% CI -14.41 to -3.39) Secondary outcomes No significant difference in stroke or death at 1 year (23% vs. 29%; ARD -6, 95% CI -13.77 to 1.77) Significant decrease in any stroke (19% vs. 26%; ARD -7, 95% CI -13.91 to -0.09) Safety outcomes No significant differences in disabling or fatal stroke, major non-stroke hemorrhage. Significant difference in any major hemorrhage (4% vs. 13%). Conclusion In patients with recent TIA or stroke related to 70-99% stenosis of a major intracranial artery, aggressive medical management was superior to percutaneous transluminal angioplasty and stenting with respect to the rate of stroke or death within 30 days after enrolment, ischemic stroke in the territory of the qualifying artery beyond 30 days of enrolment, or any stroke or death within 30 days after a revascularization procedure of the qualifying lesion during follow-up. Reference Derdeyn CP, Chimowitz MI, Lynn MJ et al. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet. 2014 Jan 25;383(9914):333-41. https://web.pathway.md/studies/recih0Oi2meGPX9cf 2/3 6/29/23, 11:41 PM SAMMPRIS Pathway Open reference URL https://web.pathway.md/studies/recih0Oi2meGPX9cf 3/3