A conversation with Colin Derdeyn, MD, Chair and Departmental Executive Officer of the Department of Radiology, University of Iowa Carver College of Medicine, about the late complications of stenting for intracranial atherosclerotic disease and the challenges posed by new stroke treatments.
Interviewed by José G. Merino, MD, Associate Professor of Neurology, University of Maryland School of Medicine.
They will be discussing the paper, “Nonprocedural Symptomatic Infarction and In-Stent Restenosis After Intracranial Angioplasty and Stenting in the SAMMPRIS Trial (Stenting and Aggressive Medical Management for the Prevention of Recurrent Stroke in Intracranial Stenosis),” published in the June 2017 issue of Stroke.
Dr. Merino: Good afternoon. Can you tell us what prompted this secondary analysis of the SAMMPRIS data?
Dr. Derdeyn: From SAMMPRIS, we learned that there’s potentially great value for dual antiplatelets and statins, along with aggressive risk factor management for patients with intracranial atherosclerotic disease (ICAD). We also learned that in this setting, there is a much higher complication rate from stenting than we thought, mainly due to a lot of perforator strokes, particularly in the basilar territory, and that the procedure is associated with a risk of intracranial hemorrhage, perhaps due to reperfusion. These short-term complications limit the value of stenting for ICAD.