Sami Al Kasab1, Michael J Lynn2, Tanya N Turan3, Colin P Derdeyn4, David Fiorella5, Bethany F Lane2, L Scott Janis6, Marc I Chimowitz3. 1. Department of Neurology, Medical University of South Carolina, Charleston, South Carolina. Electronic address: alkasab@musc.edu. 2. Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public, Health, Atlanta, Georgia. 3. Department of Neurology, Medical University of South Carolina, Charleston, South Carolina. 4. Department of Radiology, University of Iowa, Iowa City, Iowa. 5. Department of Neurosurgery, State University of New York, Stony Brook, New York. 6. National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
Abstract
BACKGROUND: An American Heart Association/American Stroke Association (AHA/ASA) writing committee has recently recommended that tissue evidence of cerebral infarction associated with temporary symptoms (CITS) lasting <24 hours should be considered a stroke. We analyzed the impact of considering CITS as equivalent to stroke on the results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. METHODS: We compared outcomes in the medical (n = 227) and stenting (n = 224) groups in SAMMPRIS using the following primary end point (new components in bold): any stroke, CITS, or death within 30 days after enrollment or within 30 days after a revascularization procedure for the qualifying lesion during follow-up; or ischemic stroke or CITS in the territory of the qualifying artery beyond 30 days. We also compared the use of brain magnetic resonance imaging (MRI) after transient ischemic attacks (TIAs) in both treatment groups. RESULTS: By considering CITS as equivalent to stroke, the number of primary end points increased from 34 to 43 in the medical group and from 52 to 66 in the stenting group of SAMMPRIS. The Kaplan-Meier curves for the primary end points in the 2 groups were significantly different (P = .009). The percentage of patients with reported TIAs who underwent brain MRI was 69% in the medical group and 61% in the stenting group (P = .40). CONCLUSION: Using the AHA/ASA definition of stroke resulted in a substantially higher primary end point rate in both treatment groups and an even higher benefit from medical therapy over stenting than originally shown in SAMMPRIS. The higher rate of CITS in the stenting group was not due to ascertainment bias. Published by Elsevier Inc.
RCT Entities:
BACKGROUND: An American Heart Association/American Stroke Association (AHA/ASA) writing committee has recently recommended that tissue evidence of cerebral infarction associated with temporary symptoms (CITS) lasting <24 hours should be considered a stroke. We analyzed the impact of considering CITS as equivalent to stroke on the results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. METHODS: We compared outcomes in the medical (n = 227) and stenting (n = 224) groups in SAMMPRIS using the following primary end point (new components in bold): any stroke, CITS, or death within 30 days after enrollment or within 30 days after a revascularization procedure for the qualifying lesion during follow-up; or ischemic stroke or CITS in the territory of the qualifying artery beyond 30 days. We also compared the use of brain magnetic resonance imaging (MRI) after transient ischemic attacks (TIAs) in both treatment groups. RESULTS: By considering CITS as equivalent to stroke, the number of primary end points increased from 34 to 43 in the medical group and from 52 to 66 in the stenting group of SAMMPRIS. The Kaplan-Meier curves for the primary end points in the 2 groups were significantly different (P = .009). The percentage of patients with reported TIAs who underwent brain MRI was 69% in the medical group and 61% in the stenting group (P = .40). CONCLUSION: Using the AHA/ASA definition of stroke resulted in a substantially higher primary end point rate in both treatment groups and an even higher benefit from medical therapy over stenting than originally shown in SAMMPRIS. The higher rate of CITS in the stenting group was not due to ascertainment bias. Published by Elsevier Inc.
Authors: Line Abdul Rahman; Tanya N Turan; George Cotsonis; Eyad Almallouhi; Christine A Holmstedt; Marc I Chimowitz Journal: J Stroke Cerebrovasc Dis Date: 2020-09-10 Impact factor: 2.136
Authors: Lewis B Morgenstern; Darin B Zahuranec; Jaewon Lim; Xu Shi; Devin L Brown; Kevin A Kerber; William J Meurer; Lesli E Skolarus; Eric E Adelman; Morgan S Campbell; Erin Case; Lynda D Lisabeth Journal: J Stroke Cerebrovasc Dis Date: 2021-03-21 Impact factor: 2.677
Authors: Alice Haniuda Moliterno; Fernanda Vieira Bezerra; Louanne Angélica Pires; Sarah Santos Roncolato; Talita Dias da Silva; Thais Massetti; Deborah Cristina Gonçalves Luiz Fernani; Fernando Henrique Magalhães; Carlos Bandeira de Mello Monteiro; Maria Tereza Artero Prado Dantas Journal: Biomed Res Int Date: 2020-07-22 Impact factor: 3.411