A preliminary study funded by the National Institutes of Health found that a stent designed to open clogged arteries in the brain was successfully deployed in nearly all cases and significantly reduced arterial blockage in the short term. But data on the long-term benefit of the stent, compared to medical treatment alone, were inconclusive, prompting the upcoming launch of a large-scale randomized trial that is expected to provide definitive results.

The NIH Wingspan Registry collected statistics on 129 patients who had an intracranial artery narrowed by at least 70 percent and were experiencing recurrent strokes or transient ischemic attacks (TIAs or "ministrokes") despite being on anti-clotting medication. Treatment included use of the Wingspan intracranial stent developed by Boston Scientific. Seven centers in the United States participated in the trial, and results are published online in the journal Neurology.

"Treatment options for stroke patients with severe blockages are extremely limited," said neurosurgeon Michael J. Alexander, M.D., one of the article's authors and director of the Cedars-Sinai Neurovascular Center. "As opposed to the situation in blocked heart arteries where options include angioplasty, stenting and surgical bypass, there is no surgical option for these blockages in the brain. This stent may be a major advance for patients with high-grade stenosis (arterial narrowing) who have a stroke or TIA. Previously they could just take medication and expect to have a high recurrent stroke rate."

Before coming to Cedars-Sinai in 2007, Dr. Alexander was founder and director of the Neurovascular Center at Duke University, where he was one of the Wingspan study leaders.

"We know that patients with 70 percent to 99 percent stenosis and TIA or stroke within the previous 30 days are at highest risk of having another stroke," Dr. Alexander said. "These are the patients who have the most to gain from stenting and are the ones we will target for enrollment in the randomized trial of stenting versus medical therapy."

As a member of the steering committee for the upcoming prospective randomized trial -- Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) -- Dr. Alexander expects Cedars-Sinai to be one of several large centers in the state participating.