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 J Stern; Colin P Derdeyn; David Fiorella; Marc I Chimowitz

doi:10.1159/000358120

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Intracranial stenosis: impact of randomized trials on treatment preferences of US neurologists and neurointerventionists

Journal article

Open access

Peer reviewed

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 J Stern, Colin P Derdeyn, David Fiorella and Marc I Chimowitz

Cerebrovascular diseases (Basel, Switzerland), Vol.37(3), pp.203-211

2014

DOI: 10.1159/000358120

PMCID: PMC3991561

PMID: 24557055

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https://doi.org/10.1159/000358120View

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Abstract

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). 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. 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%). 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.

Ticlopidine - therapeutic use

Constriction, Pathologic

United States

Humans

Secondary Prevention

Drug Utilization

Aspirin - administration & dosage

Warfarin - therapeutic use

Practice Patterns, Physicians' - statistics & numerical data

Radiology, Interventional

Fibrinolytic Agents - therapeutic use

Ticlopidine - administration & dosage

Surveys and Questionnaires

Aspirin - therapeutic use

Drug Therapy, Combination

Intracranial Arteriosclerosis - pathology

Stroke - prevention & control

Risk Reduction Behavior

Stents - utilization

Ticlopidine - analogs & derivatives

Randomized Controlled Trials as Topic

Stroke - etiology

Cerebral Arteries - pathology

Intracranial Arteriosclerosis - therapy

Neurology - statistics & numerical data

Angioplasty - utilization

Health Care Surveys

Intracranial Arteriosclerosis - complications

Details

Title: Subtitle: Intracranial stenosis: impact of randomized trials on treatment preferences of US neurologists and neurointerventionists
Creators: Tanya N Turan - Medical University of South Carolina, Charleston, S.C., USA
George Cotsonis
Michael J Lynn
Rahim H Wooley
Seegar Swanson
Janice E Williams
Barney J Stern
Colin P Derdeyn
David Fiorella
Marc I Chimowitz
Resource Type: Journal article
Publication Details: Cerebrovascular diseases (Basel, Switzerland), Vol.37(3), pp.203-211
Publisher: Switzerland
DOI: 10.1159/000358120
PMID: 24557055
PMCID: PMC3991561
ISSN: 1015-9770
eISSN: 1421-9786
Grant note: R01 NS051688 / NINDS NIH HHS R01NS36643 / NINDS NIH HHS R01NS051688 / NINDS NIH HHS R01 NS036643 / NINDS NIH HHS U01 NS058728 / NINDS NIH HHS K23NS069668 / NINDS NIH HHS K24 NS050307 / NINDS NIH HHS UL1 TR000062 / NCATS NIH HHS K23 NS069668 / NINDS NIH HHS
Language: English
Date published: 2014
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984020752802771

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