Stroke; a journal of cerebral circulation
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The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis (SAMMPRIS) trial, a randomized clinical trial comparing aggressive medical management to stenting with aggressive medical management for symptomatic intracranial stenosis, was prematurely halted when a high rate of periprocedural events was found in the stent arm. The trial also demonstrated a high rate of stroke with medical management. This article explores possible reasons for these outcomes and discusses some weaknesses of the trial. Against this background endovascular therapy should continue to be explored in the treatment of this disease.
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Meta Analysis
Renin-Angiotensin system modulators modestly reduce vascular risk in persons with prior stroke.
Although the efficacy of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in reducing future vascular events for patients with coronary heart disease is established, less is known about the precise benefit of these agents among patients with stroke. We evaluated whether use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers reduces future vascular events in persons with prior stroke. ⋯ Treatment with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker has a clear but rather modest effect on reducing vascular risk in persons with prior stroke.
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Differences in definitions of socioeconomic status and between study designs hinder their comparability across countries. We aimed to analyze the correlation between 3 widely used macrosocioeconomic status indicators and clinical outcomes. ⋯ Lower per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity were associated with higher incident risk of stroke, higher case-fatality, a greater proportion of hemorrhagic strokes, and lower age at stroke onset. As a result, these macrosocioeconomic status indicators may be used as proxy measures of quality of primary prevention and acute care and considered as important factors for developing strategies aimed at improving worldwide stroke care.