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London, United Kingdom 2013 15 Interesting and challenging cases Failure of aggressive medical treatment in a case of recurrent stroke due to stenosis of the mean cerebral artery : still a place for stenting despite the results of SAMMPRIS study ? Ps. Desfontaines1, D. Brisbois2, S. Van Snick3 Centre Hospitalier Chrétien, Department of Neurology, Liège, BELGIUM1, Centre Hospitalier Chrétien, Department of Neuroradiology, Liège, BELGIUM2, Centre Hospitalier Chrétien, Depart-ment of Neurology, Liège, BELGIUM3 Background : severe (more than 70%) intracranial artery stenosis (ICAS) is associated with a high risk of recurrent stroke (23% at one year), particularly after a first stroke or TIA. The SAMMPRIS study showed that aggressive medical treatment combining antiplatelet therapy and intensive man-agement of risk factors was superior to percutaneous transluminal angioplasty and stenting (PTAS), because of a higher rate of early stroke after PTAS (14,7%) than with aggressive medical therapy alone (5,8%). Material and methods : we describe the case of a 56 year old man admitted in april 2012 because of a stroke in the mean cerebral artery territory (MCA). The MRI confirmed an acute ischemic stroke and a proximal (M1) stenosis of the right MCA. The vascular risk factors were : tobacco, hypercholesterolemia and diabetes mellitus. The patient was already treated by aspirine 80 mg, rosuvastatine 40 mg and metformine 850 mg bid. Clopidogrel 75 mg was added. Two months later, he experienced another stroke and the MRI showed another acute ischemic stroke in the same territory with small scattered infarctions, probably of embolic origin from the stenosis. A cerebral angiography was performed and confirmed a 80% stenosis of the M1 portion of the right MCA. A PTAS was performed, with the PRO KINETIC 2,25x9 mm device (balloon-mounted stent). Results : at a 6 months follow up, no recurrent stroke nor TIA occurred. The MRI and angiography showed a residual stenosis of 30%. Conclusion : this case illustrates the usefulness to keep the intracranial stenting as an optional treatment in cases with failure of aggressive medical treatment. SAMMPRIS study did not use other device than the Wingspan stent system, such as balloon-mounted stents or angioplasty alone, so that other trials using other devices and restricted to patients with failure of ag-gressive medical treatment may be considered in order to better define the indications of endovascu-lar treatment of intracranial stenosis E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 275


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