Stroke

ACAS (1995): Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995;273:1421-8. - treatment: carotid endarterectomy - control: aspirin 325 mg daily - population: asymptomatic carotid artery stenosis of 60% or greater - method: RCT - follow-up: 2.7 years mean - primary end-point: ipsilateral stroke or any perioperative stroke or death - outcome: perioperative stroke or death or subsequent ipsilateral stroke: treatment 4.0%, control 6.2%, relative risk 0.64, 95% CI 0.42-0.98, absolute risk reduction -22.4%

NINDS-tPA 1 and 2 (1995): Tissue Plasminogen Activator for Acute Ischemic Stroke. NEJM 1995;333 1581-7. - treatment: t-PA 0.9 mg/kg (max 90 mg) 10% given as bolus followed by 90% as constant infusion over 60 minutes - control: placebo - population: ischemic stroke with clearly defined time of onset, deficit measurable on NIHSS, and baseline CT showing no evidence of ICH - method: RCT, intention-to-treat - follow-up: part 1- 24h, part 2- 3 months - primary end-point: part 1- complete resolution of neurologic deficit or NIHSS recovery of >=4 at 24h after stroke, part 2- minimal or no deficits 3 months after treatment - outcome: - funded by Genentech

ATLANTIS

ECASS

SPARCL (2006): High-Dose Atorvastatin after Stroke or Transient Ischemic Attack. NEJM 2006; 355:549-559 - treatment: atorvastatin 80mg daily - control: placebo - population: patients who had had a stroke or TIA within 1-6 mo., LDL 100-190 mg/dl, and no known CAD - method: RCT - follow-up: 4.9 y - primary end-point: first nonfatal or fatal stroke - outcome: first nonfatal or fatal stroke: treatment 11.2% percent, control 13.1%, 5-year absolute risk reduction 2.2%, relative risk 0.84 CI 0.71-0.99 - comments: NNT 45, small increase in hemorrhagic stroke in treatment group

SAMMPRIS (2011): Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis - treatment: percutaneous transluminal angioplasty and stenting (PTAS) and aggressive medical therapy - control: aggressive medical therapy - population: patients who had a recent TIA or stroke attributed to stenosis of 70 to 99% of the diameter of a major intracranial artery - method: RCT - follow-up: 11.9 months mean (ongoing) - primary end-point: stroke or death within 30 days after enrollment or after a revascularization procedure - outcome: stroke or death within 30 days after enrollment or after a revascularization procedure: treatment 14.7%, control 5.8%