Patients with intracranial stenosis treated medically (antithrombotic therapy, risk factor modification) have a high risk of stroke in the territory of the stenotic artery. This finding, coupled with recent advances in micro catheter, balloon, and stent technology, has led to consideration of intracranial stenting as an alternative treatment for these patients. A previous multicenter Phase I trial (SSYLVIA) that evaluated a bare metal stent in patients with symptomatic intracranial stenosis showed that stenting could be performed safely and with high technical success, but the 6-month restenosis rate was high and was frequently associated with recurrent ischemia. The success of drug-eluting stents in the coronary circulation for preventing restenosis raises the possibility that these stents may also be effective in the cerebral vessels, which may be particularly susceptible to restenosis. The current study is a Phase I trial that will evaluate the safety, performance, 6-month restenosis rate, and 1-year outcome associated with the use of a drug-eluting stent (CYPHER TM , Cordis Neurovascular, Inc.) in 65 patients with symptomatic 50% - 99% stenosis of a major intracranial artery (MCA, carotid, basilar, vertebral). All patients will be followed for 1 year after stenting and will receive aspirin 325 mg per day for the entire follow-up period and clopidogrel for 90 days after stenting. Regular evaluations of all study patients will be performed at study entry and 24 hours, 3 months, 6 months, 9 months, and 12 months after stenting. A single vessel cerebral angiogram will be performed on all patients 6 months after stenting to evaluate the presence of restenosis. The primary endpoint is all stroke and death within 30 days of stenting. Secondary endpoints include restenosis (> 50%) at 6 months, ischemic stroke in the territory of the treated artery within 12 months, death within 12 months, non-fatal myocardial infarction within 12 months, major systemic hemorrhage or any intracranial hemorrhage within 12 months. This study will: i) determine the safety, performance, and potential efficacy of a drug-eluting for treating intracranial stenosis ii) pave the way for a Phase III trial comparing stenting combined with medical therapy vs. medical therapy alone for this disease. ? ?
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