Intracranial stenosis

Impact of randomized trials on treatment preferences of us neurologists and neurointerventionists

Tanya N. Turan, George Cotsonis, Michael J. Lynn, Rahim H. Wooley, Seegar Swanson, Janice E. Williams, Barney Stern, Colin P. Derdeyn, David Fiorella, Marc I. Chimowitz

Research output: Contribution to journalArticle

Abstract

Background and Purpose: Medical and endovascular treatment options for stroke prevention in patients with symptomatic intracranial stenosis have evolved over the past several decades, but the impact of 2 major multicenter randomized stroke prevention trials on physician practices has not been studied. We sought to determine changes in US physician treatment choices for patients with intracranial atherosclerotic stenosis (ICAS) following 2 NIH-funded clinical trials that studied medical therapies (antithrombotic agents and risk factor control) and percutaneous transluminal angioplasty and stenting (PTAS). Methods: Anonymous surveys on treatment practices in patients with ICAS were sent to physicians at 3 time points: before publication of the NIH-funded Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial (pre-WASID survey, 2004), 1 year after WASID publication (post-WASID survey, 2006) and 1 year after the publication of the NIH-funded Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial (post-SAMMPRIS survey, 2012). Neurologists were invited to participate in the pre-WASID survey (n = 525). Neurologists and neurointerventionists were invited to participate in the post-WASID (n = 598) and post-SAMMPRIS (n = 2,080) surveys. The 3 surveys were conducted using web-based survey tools delivered by E-mail, and a fax-based response form delivered by E-mail and conventional mail. Data were analyzed using the χ2 test. Results: Before WASID, there was equipoise between warfarin and aspirin for stroke prevention in patients with ICAS. The number of respondents who recommended antiplatelet treatment for ICAS increased across all 3 surveys for both anterior circulation (pre-WASID = 44%, post-WASID = 85%, post-SAMMPRIS = 94%) and posterior circulation (pre-WASID = 36%, post-WASID = 74%, post-SAMMPRIS = 83%). The antiplatelet agent most commonly recommended after WASID was aspirin, but after SAMMPRIS it was the combination of aspirin and clopidogrel. The percentage of neurologists who recommended PTAS in >25% of ICAS patients increased slightly from pre-WASID (8%) to post-WASID surveys (12%), but then decreased again after SAMMPRIS (6%). The percentage of neurointerventionists who recommended PTAS in >25% of ICAS patients decreased from post-WASID (49%) to post-SAMMPRIS surveys (17%). Conclusions: The surveyed US physicians' recommended treatments for ICAS differed over the 3 survey periods, reflecting the results of the 2 NIH-funded clinical trials of ICAS and suggesting that these clinical trials changed practice in the USA.

Original languageEnglish (US)
Pages (from-to)203-211
Number of pages9
JournalCerebrovascular Diseases
Volume37
Issue number3
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Warfarin
Aspirin
Pathologic Constriction
Stroke
Therapeutics
Angioplasty
Physicians
Publications
Neurologists
clopidogrel
Clinical Trials
Surveys and Questionnaires
Telefacsimile
Fibrinolytic Agents
Platelet Aggregation Inhibitors
Postal Service

Keywords

  • Cerebral arteries
  • Intracranial stenosis
  • Survey
  • Treatment practices

ASJC Scopus subject areas

  • Neurology
  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology

Cite this

Turan, T. N., Cotsonis, G., Lynn, M. J., Wooley, R. H., Swanson, S., Williams, J. E., ... Chimowitz, M. I. (2014). Intracranial stenosis: Impact of randomized trials on treatment preferences of us neurologists and neurointerventionists. Cerebrovascular Diseases, 37(3), 203-211. https://doi.org/10.1159/000358120

Intracranial stenosis : Impact of randomized trials on treatment preferences of us neurologists and neurointerventionists. / Turan, Tanya N.; Cotsonis, George; Lynn, Michael J.; Wooley, Rahim H.; Swanson, Seegar; Williams, Janice E.; Stern, Barney; Derdeyn, Colin P.; Fiorella, David; Chimowitz, Marc I.

In: Cerebrovascular Diseases, Vol. 37, No. 3, 01.01.2014, p. 203-211.

Research output: Contribution to journalArticle

Turan, TN, Cotsonis, G, Lynn, MJ, Wooley, RH, Swanson, S, Williams, JE, Stern, B, Derdeyn, CP, Fiorella, D & Chimowitz, MI 2014, 'Intracranial stenosis: Impact of randomized trials on treatment preferences of us neurologists and neurointerventionists', Cerebrovascular Diseases, vol. 37, no. 3, pp. 203-211. https://doi.org/10.1159/000358120
Turan, Tanya N. ; Cotsonis, George ; Lynn, Michael J. ; Wooley, Rahim H. ; Swanson, Seegar ; Williams, Janice E. ; Stern, Barney ; Derdeyn, Colin P. ; Fiorella, David ; Chimowitz, Marc I. / Intracranial stenosis : Impact of randomized trials on treatment preferences of us neurologists and neurointerventionists. In: Cerebrovascular Diseases. 2014 ; Vol. 37, No. 3. pp. 203-211.
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T2 - Impact of randomized trials on treatment preferences of us neurologists and neurointerventionists

AU - Turan, Tanya N.

AU - Cotsonis, George

AU - Lynn, Michael J.

AU - Wooley, Rahim H.

AU - Swanson, Seegar

AU - Williams, Janice E.

AU - Stern, Barney

AU - Derdeyn, Colin P.

AU - Fiorella, David

AU - Chimowitz, Marc I.

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N2 - Background and Purpose: Medical and endovascular treatment options for stroke prevention in patients with symptomatic intracranial stenosis have evolved over the past several decades, but the impact of 2 major multicenter randomized stroke prevention trials on physician practices has not been studied. We sought to determine changes in US physician treatment choices for patients with intracranial atherosclerotic stenosis (ICAS) following 2 NIH-funded clinical trials that studied medical therapies (antithrombotic agents and risk factor control) and percutaneous transluminal angioplasty and stenting (PTAS). Methods: Anonymous surveys on treatment practices in patients with ICAS were sent to physicians at 3 time points: before publication of the NIH-funded Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial (pre-WASID survey, 2004), 1 year after WASID publication (post-WASID survey, 2006) and 1 year after the publication of the NIH-funded Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial (post-SAMMPRIS survey, 2012). Neurologists were invited to participate in the pre-WASID survey (n = 525). Neurologists and neurointerventionists were invited to participate in the post-WASID (n = 598) and post-SAMMPRIS (n = 2,080) surveys. The 3 surveys were conducted using web-based survey tools delivered by E-mail, and a fax-based response form delivered by E-mail and conventional mail. Data were analyzed using the χ2 test. Results: Before WASID, there was equipoise between warfarin and aspirin for stroke prevention in patients with ICAS. The number of respondents who recommended antiplatelet treatment for ICAS increased across all 3 surveys for both anterior circulation (pre-WASID = 44%, post-WASID = 85%, post-SAMMPRIS = 94%) and posterior circulation (pre-WASID = 36%, post-WASID = 74%, post-SAMMPRIS = 83%). The antiplatelet agent most commonly recommended after WASID was aspirin, but after SAMMPRIS it was the combination of aspirin and clopidogrel. The percentage of neurologists who recommended PTAS in >25% of ICAS patients increased slightly from pre-WASID (8%) to post-WASID surveys (12%), but then decreased again after SAMMPRIS (6%). The percentage of neurointerventionists who recommended PTAS in >25% of ICAS patients decreased from post-WASID (49%) to post-SAMMPRIS surveys (17%). Conclusions: The surveyed US physicians' recommended treatments for ICAS differed over the 3 survey periods, reflecting the results of the 2 NIH-funded clinical trials of ICAS and suggesting that these clinical trials changed practice in the USA.

AB - Background and Purpose: Medical and endovascular treatment options for stroke prevention in patients with symptomatic intracranial stenosis have evolved over the past several decades, but the impact of 2 major multicenter randomized stroke prevention trials on physician practices has not been studied. We sought to determine changes in US physician treatment choices for patients with intracranial atherosclerotic stenosis (ICAS) following 2 NIH-funded clinical trials that studied medical therapies (antithrombotic agents and risk factor control) and percutaneous transluminal angioplasty and stenting (PTAS). Methods: Anonymous surveys on treatment practices in patients with ICAS were sent to physicians at 3 time points: before publication of the NIH-funded Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial (pre-WASID survey, 2004), 1 year after WASID publication (post-WASID survey, 2006) and 1 year after the publication of the NIH-funded Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial (post-SAMMPRIS survey, 2012). Neurologists were invited to participate in the pre-WASID survey (n = 525). Neurologists and neurointerventionists were invited to participate in the post-WASID (n = 598) and post-SAMMPRIS (n = 2,080) surveys. The 3 surveys were conducted using web-based survey tools delivered by E-mail, and a fax-based response form delivered by E-mail and conventional mail. Data were analyzed using the χ2 test. Results: Before WASID, there was equipoise between warfarin and aspirin for stroke prevention in patients with ICAS. The number of respondents who recommended antiplatelet treatment for ICAS increased across all 3 surveys for both anterior circulation (pre-WASID = 44%, post-WASID = 85%, post-SAMMPRIS = 94%) and posterior circulation (pre-WASID = 36%, post-WASID = 74%, post-SAMMPRIS = 83%). The antiplatelet agent most commonly recommended after WASID was aspirin, but after SAMMPRIS it was the combination of aspirin and clopidogrel. The percentage of neurologists who recommended PTAS in >25% of ICAS patients increased slightly from pre-WASID (8%) to post-WASID surveys (12%), but then decreased again after SAMMPRIS (6%). The percentage of neurointerventionists who recommended PTAS in >25% of ICAS patients decreased from post-WASID (49%) to post-SAMMPRIS surveys (17%). Conclusions: The surveyed US physicians' recommended treatments for ICAS differed over the 3 survey periods, reflecting the results of the 2 NIH-funded clinical trials of ICAS and suggesting that these clinical trials changed practice in the USA.

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KW - Intracranial stenosis

KW - Survey

KW - Treatment practices

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