Concluded Case

Left MCA stroke with 90 % stenosis in a 69 yr old female

A 69 yr ,F, with a recent stroke in the distribution of left MCA has 90 % stenosis in the M2 segment of left MCA.Known diabetic and hypertensive ,well under control.In addition to statin and good control of DM and hypertension which of the following is indicated ?. A antiplatelet B MCA angioplasty and stenting C MCA bypass surgery. D non- vit k antagonist oral anticoagulant E warfarin

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Thanks Dr Krishnendu for the correct answer. A - Antiplatelet is the correct answer. The SAMMPRIS ( Stentingand Aggressive Medical Management for the Prevention of RecurrentIschemic Stroke) trial demonstrated that patients with 70 to 90 % intracranial stenosis did better with maximal medical management than with angioplasty and stenting.The WASID ( Warfarin- Aspirin Symptomatic Disease) trial demonstrated no benefit for warfarin over aspirin in patients with symptomatic intracranial stenosis,but warfarin was associated with significant higher rates of adverse events.There is no evidence to support the use of non vit k antagonist in this settings ,and no studies have established a role for middle cerebral artery bypass surgery .
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Thanks Dr Krishnendu for the correct answer. A - Antiplatelet is the correct answer. The SAMMPRIS ( Stentingand Aggressive Medical Management for the Prevention of RecurrentIschemic Stroke) trial demonstrated that patients with 70 to 90 % intracranial stenosis did better with maximal medical management than with angioplasty and stenting.The WASID ( Warfarin- Aspirin Symptomatic Disease) trial demonstrated no benefit for warfarin over aspirin in patients with symptomatic intracranial stenosis,but warfarin was associated with significant higher rates of adverse events.There is no evidence to support the use of non vit k antagonist in this settings ,and no studies have established a role for middle cerebral artery bypass surgery .
Antiplatelets
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