Consensus of ICAD treatment after SAMMPRIS in China Zhujiang Hospital Zhujiang Hospital Nanfang Medical University Liu Yajie, MD Pros &Cons of PTAS in ICAD Zhujiang Hospital Zhujiang Hospital Nanfang Medical University Liu Yajie, MD

Kasner SE, et al. Circulation. 2006;113: HR=2.03,P = We will Continue with Clinical Trials

AMT superior to PTAS by 30-day rates of Stroke and Death Chimowitz MI et al. N Engl J Med.365(11): SAMMPRIS Results

Whacan we learn from SAMMPRIS? Should we stop PTAS after SAMMPRIS? Should we consider future clinical trials? Does PTAS do more harm ?

Operator 20 most recent consecutive cases of intracranial stenting or angioplasty. 1. Wingspan ™ Stent System 2. Balloon-mounted coronary stent 3. Self-expanding stent for aneurysm 4. Angioplasty alone A minimum of 3 Wingspan ™ Stent System cases was required to be considered for credentialing. Average 3-4 procedures / enrolled doctor, when SAMMPRIS was halted. Chimowitz MI et al.J Stroke Cerebrovasc Dis 20(4): Chimowitz NEJM 2011

CAS Learning Curve – 72 CASES for Matured Operator William A. Gray,et al.J Am Coll Cardiol Intv 2011;4:235– 46

Facilitate More Complex PTAS

Zaidat OO, et al. Neurology. 2008;70:1518–1524 Primary end point ： 30d Stroke or death/ ipsilateral stroke after 3 months Primary end point (%) 总体 24 小时 30 天 6 个月 NIH Wingspan ™ Stent System had lower event rate in low volume centers vs. high volume centers, operator skill is key factor in PTAS P=0.022 Learning Curve for PTAS?

S GAO, et al.Front Neurol Feb 15;2:6. Pathogenesis and PTAS Patient

PTAS not suitable for PA occluded patients

Hemodynamic impaired more suitable for PTAS Pathogenesis and PTAS

Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Kasner SE, Chimowitz MI, Lynn NJ, et al.: Circulation 2006, 113: Timing

Chimowitz MI et al. N Engl J Med.365(11):

F. Nahab et al.Neurology Jun 9;72(23): Wingspan ™ Stent System- Time Selection and Complication Rate

Patients enrolled Follow up Clopidogrel™ 75mg day 1-5 AMT PTAS Clopidogrel™ 75mg day 1-5, with option of loading dose between 6 and 24 hours prior to PTAS Clopidogrel™ 75mg daily DAY 90 Randomized Chimowitz Journal of Stroke and Cerebrovascular Diseases, Vol. 20, No. 4 (July - August), 2011: pp Different Antiplatelet Therapy in 2 Groups *Not all patients received the 600mg loading dose. Medicine

Chimowitz MI, Lynn MJ, Derdeyn CP, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011;365:

DOI: /cma.j.issn Interventional therapy is one of the therapies to treat symptomatic ICAD patients. As inadequate evidence based, it should be a supplemental therapy for medical treatment, it can be conducted in selective patents. Interventional therapy could be a supplemental therapy for ICAD patients whose vessels have ≥70% stenosis, and who are refractory to standard medical therapy with non/low collateral circulation. Chinese Experts’ Consensus of Symptomatic ICAD PTAS Treatment

Summary PTAS performed by an experienced Operator in a hemodynamic impaired Patient at the right Timing with with adequate Medicine benefit all. Otherwise, it may harms everyone.