Preconditioning reaches clinical practice in intracranial arterial stenosis.
Symptomatic atherosclerotic intracranial arterial stenosis is a common etiologic mechanism of ischemic stroke. Patients with intracranial arterial stenosis carry a high risk of recurrent stroke that persists even with aggressive preventive measures.(1) The growing popularity of endovascular interventions for intracranial arterial stenosis, such as percutaneous transluminal angioplasty and stenting (PTAS), has spurred hope that such an approach might reduce stroke recurrence and the substantial resulting morbidity. While not without its controversies, the recently presented results of the SAMMPRIS study (ClinicalTrials.gov number NCT00576693), a randomized controlled trial comparing aggressive medical management to PTAS in patients with intracranial arterial stenosis and recent stroke or TIA, found that PTAS might actually increase the risk of stroke recurrence.(2) Consequently, a demand endures for alternative therapies to reduce recurrent stroke risk in intracranial arterial stenosis.