Intracranial Stenosis: Stenting and Aggressive Medical Management for Preventing Recurrent Stroke
Guest: Dr. Tanya Turan – Neurosciences, MUSC
Host: Dr. Linda Austin – Psychiatry, MUSC
Dr. Linda Austin: Dr. Tanya Turan is Assistant Professor of Neurology here at the Medical University of South Carolina. Dr. Turan, you’re doing three studies on patients who have atherosclerosis, or hardening of the arteries, within the brain. Now, this particular study has a very long title. So, why don’t you tell us what it is and then break that down, and explain it in lay terms.
Dr. Tanya Turan: Sure. We call it SAMMPRIS for short: Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis. It’s a long name for a study, which is a comparative clinical trial that’s going on at several centers throughout the United States; which is studying two different treatments for a condition called intracranial stenosis, which means hardening of the brain arteries. It’s comparing two treatments: stenting with a wingspan stent, and aggressive medical therapy. And these are both treatments that are thought to be useful for preventing stroke in people who’ve had a stroke, or TIA, related to intracranial stenosis in the past.
Dr. Linda Austin: So, let’s talk about each of those. First of all, tell us about the stenting procedure. How is that done?
Dr. Tanya Turan: The stenting procedure is a relatively invasive procedure. It starts off similar to a regular cerebral angiogram, which is kind of like a coronary cath; which some people may have heard of before. A catheter is inserted into one of the blood vessels in the top of the leg and works its way up to the brain arteries. And this is done by a very experienced person; an interventional neuroradiologist. There’s an angioplasty balloon which opens up the narrowing in the brain artery, and then a stint is put in on top of that.
Dr. Linda Austin: And, how long does that procedure take?
Dr. Tanya Turan: Usually, it just takes a few hours. Patients do need to be under general anesthesia; or put to sleep, for that procedure. Not all patients in the study will get that procedure because it’s a comparative study. We’re testing to see how patients do with that procedure, and getting the stent put in, versus those who get just aggressive medical management.
Dr. Linda Austin: And, what does aggressive medical management consist of?
Dr. Tanya Turan: Well, we know that in people with narrowing of the brain arteries, having high cholesterol and high blood pressure are big risk factors for having another stroke, or TIA. So, with aggressive medical management, we’re working with the patient very closely to try to get the cholesterol and blood pressure under very tight control. As part of that, we’re also using a lifestyle intervention program, which is based out of Savannah, where each patient will be assigned a mentor that they’ll talk to on the phone, who will help them with recommendations related to diet and exercise, management of diabetes, stress reduction; all those risk factors which can predispose to another stroke.
Dr. Lind Austin: Are patients randomized? Is there a coin toss to determine whether a given patient in the study will get the one procedure or the other?
Dr. Tanya Turan: Yes. Because we don’t know which treatment is better, the patients are randomly assigned to one treatment or the other. I should note that the patients that get the stent also get aggressive medical management, in addition to the stint. So, with both groups of patients in the study, we’re counseling patients and modifying their risk factors very strongly to get their cholesterol and blood pressure under good control.
Dr. Linda Austin: Sometimes with these sorts of studies, there’s a so-called sham procedure so that it’s blind, at least, to the patient. The patients who are randomized to medical treatment, do they get any kind of catheterization or anything, or is it a nonblinded study?
Dr. Tanya Turan: In order to qualify for the study, every patient does need an angiogram at some point to diagnose the condition. But there’s no sham procedure done in the patients randomized or assigned to the medical group.
Dr. Linda Austin: So, all patients know which treatment arm they’re in? Is that right?
Dr. Tanya Turan: Yes, they do.
Dr. Linda Austin: If a patient is interested in participating in what, I think, is a really important study; as we’re trying to understand more about these techniques, who should they call?
Dr. Tanya Turan: They can contact me or our coordinator, Genevieve Starr, at (843) 792-3020.
Dr. Linda Austin: Dr. Turan, thank you so much for talking with us today. Good luck.
Dr. Tanya Turan: Thank you.