Aggressive medical management may provide more benefit than percutaneous transluminal angioplasty and stenting (PTAS) for high-risk patients with atherosclerotic intracranial arterial stenosis, according to a study published online ahead of print October 26 in Lancet. Investigators randomized 451 patients with recent transient ischemic attack or stroke to aggressive medical management or aggressive medical management plus stenting with the Wingspan stent. The cumulative probability of stroke or death was smaller in the medical group vs the PTAS group. Beyond 30 days, 10% of patients in the medical group and 10% of patients in the stenting group had a primary end point. The absolute differences in the primary end point rates between the two groups were 7.1% at year 1, 6.5% at year 2 and 9.0% at year 3.
—Erik Greb
Senior Associate Editor