This Article Full Text Full Text (PDF) All Versions of this Article: 38/4/1420    most recent 01.STR.0000259845.00988.2bv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kasner, S. E. Search for Related Content PubMed PubMed Citation Articles by Kasner, S. E. Related Collections Angioplasty and Stenting

(Stroke. 2007;38:1420.)
© 2007 American Heart Association, Inc.

Controversies in Stroke

Middle Cerebral Artery Stenosis: Stenting Is One of the Options

No

From the Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, Pa.

Correspondence to Scott E. Kasner, MD, Comprehensive Stroke Center, Department of Neurology, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104. E-mail kasner@mail.med.upenn.edu

Key Words: MCA • stenting

An extract of the first 250 words of the full text is provided, because this article has no abstract.

There is no doubt that stenting can widen a narrowed intracranial artery. However, serious questions remain about the role of this intervention in clinical practice. Medical technology often leaps into practice ahead of the science needed to support its widespread application. This is particularly common with new devices, which are not required to have demonstrated efficacy or safety with the same rigor as new medications. Moreover, they are not required to be superior to existing therapies. This is a flaw in the US regulatory system, and the premature approval of devices under humanitarian device exemptions often results in a "shoot first, ask questions later" approach that hampers subsequent attempts to determine whether these devices are actually beneficial.

The Warfarin versus Aspirin for Symptomatic Intracranial Disease (WASID) trial, the only large prospective study of intracranial stenosis, showed that patients with a stroke or transient ischemic attack attributable to 50% stenosis of a major intracranial artery (internal carotid siphon, middle cerebral artery, vertebral artery, or basilar artery) confront a 12% per year risk of recurrent stroke in the territory of the stenosis, with the majority of strokes occurring in the first year.^1,2 Despite longstanding beliefs that stenoses of some arteries pose different risks than others, WASID showed that patients with disease of the middle cerebral artery were no better or worse off than those with stenosis of another major artery,^2,3 so I will address the treatment of all the major intracranial arteries based on the available evidence. Warfarin was not more effective . . . [Full Text of this Article]