Can interventions for Intracranial vascular disease prevent stroke better than medical therapies?
Carotid artery disease is recognized as a predisposing factor for the stroke in the diabetic or elderly hypertensive patients. The stroke in such patients is prevented by medical therapies and interventions. Segmental extra cranial carotid artery disease is amenable for endarterectomy or angioplasty stenting. But the intracranial vascular disease is not easily amenable for the operations or interventions. After succeeding with angioplasty and stenting of the extra cranial vessels the attention is now focused on the intracranial vascular repairs with angioplasty and stenting. The intracranial vessels are small and delicate. They can need much more careful handling and softer devices to pass through them and at the same time hard enough to dilate stenotic lesions.The 30-day rate of stroke or death associated with stenting in the SAMMPRIS trial (14.7%) is nearly 2.5 times as high as the 6% rate associated with stenting of symptomatic extracranial carotid-artery stenoses in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST, NCT00004732).
Carotid artery disease is recognized as a predisposing factor for the stroke in the diabetic or elderly hypertensive patients. The stroke in such patients is prevented by medical therapies and interventions. Segmental extra cranial carotid artery disease is amenable for endarterectomy or angioplasty stenting. But the intracranial vascular disease is not easily amenable for the operations or interventions. After succeeding with angioplasty and stenting of the extra cranial vessels the attention is now focused on the intracranial vascular repairs with angioplasty and stenting. The intracranial vessels are small and delicate. They can need much more careful handling and softer devices to pass through them and at the same time hard enough to dilate stenotic lesions.The 30-day rate of stroke or death associated with stenting in the SAMMPRIS trial (14.7%) is nearly 2.5 times as high as the 6% rate associated with stenting of symptomatic extracranial carotid-artery stenoses in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST, NCT00004732). 
