Analysis of Possible Factors Related to Periprocedural Events in SAMMPRIS Published

October 1, 2012—In Stroke, David Fiorella, MD, et al, published a detailed analysis of periprocedural strokes in patients undergoing intracranial stenting in the SAMMPRIS trial (2012;43:2682–2688).

The investigators advised that enrollment in the SAMMPRIS trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) was halted due to the high risk of stroke or death within 30 days of enrollment in the percutaneous transluminal angioplasty (PTA) and stenting arm relative to the medical arm. Bivariate and multivariate analyses were performed to evaluate whether patient and procedural variables were associated with cerebral ischemic or hemorrhagic events occurring within 30 days of enrollment in the PTA and stenting arm.

As detailed in Stroke, of the 224 patients randomized to PTA and stenting, 213 underwent angioplasty alone (n = 5) or with stenting (n = 208). Of these, 13 had hemorrhagic strokes (7 parenchymal, 6 subarachnoid), 19 had ischemic stroke, and two had cerebral infarcts with temporary signs within the periprocedural period. Ischemic events were categorized as perforator occlusions (13), embolic (4), mixed perforator and embolic (2), and delayed stent occlusion (2).

The investigators reported that multivariate analyses showed higher percent stenosis, lower modified Rankin score, and clopidogrel load associated with an activated clotting time above the target range were associated with hemorrhagic stroke (P ≤ .05). Nonsmoking, basilar artery stenosis, diabetes, and older age were associated with ischemic events (P ≤ .05).

In their conclusion, the investigators stated that periprocedural strokes in SAMMPRIS had multiple causes, with the most common being perforator occlusion. Although risk factors for periprocedural strokes could be identified, excluding patients with these features from undergoing PTA and stenting to lower the procedural risk would limit PTA and stenting to a small subset of patients. Given the small number of events, the present data should be used for hypothesis generation rather than to guide patient selection in clinical practice, advised the investigators in Stroke.