The SAMMPRIS trial compared aggressive medical therapy with percutaneous transluminal angioplasty and stenting (PTAS) in patients with intracranial arterial stenosis. The study enrolled 451 patients who had a recent transient ischemic attack or stroke due to stenosis of 70 to 99% in a major intracranial artery. The primary endpoint was stroke or death within 30 days, or stroke in the territory of the qualifying artery beyond 30 days. Aggressive medical therapy included aspirin, clopidogrel, and management of risk factors. PTAS involved the use of the Wingspan stent system. The trial found that aggressive medical therapy was superior to PTAS, with a 30-day stroke or death rate of 14.7% in the PTAS group versus 5.8% in the medical management group (P = 0.002). Beyond 30 days, stroke rates were similar in both groups. The 1-year primary endpoint rate was 20.0% in the PTAS group and 12.2% in the medical management group. The high rate of periprocedural stroke in the PTAS group (14.7% within 30 days) and the lower rate of stroke in the medical management group (5.8%) indicated that aggressive medical therapy was more effective in preventing stroke. The trial also found that the risk of stroke in the medical management group was lower than expected, suggesting that aggressive medical therapy could be more effective than PTAS in this population. The study concluded that aggressive medical therapy was superior to PTAS in patients with intracranial arterial stenosis, as the risk of early stroke after PTAS was high and the risk of stroke with aggressive medical therapy alone was lower than expected. The trial was funded by the National Institute of Neurological Disorders and Stroke and others. The results highlight the importance of aggressive medical management in preventing stroke in patients with intracranial arterial stenosis.The SAMMPRIS trial compared aggressive medical therapy with percutaneous transluminal angioplasty and stenting (PTAS) in patients with intracranial arterial stenosis. The study enrolled 451 patients who had a recent transient ischemic attack or stroke due to stenosis of 70 to 99% in a major intracranial artery. The primary endpoint was stroke or death within 30 days, or stroke in the territory of the qualifying artery beyond 30 days. Aggressive medical therapy included aspirin, clopidogrel, and management of risk factors. PTAS involved the use of the Wingspan stent system. The trial found that aggressive medical therapy was superior to PTAS, with a 30-day stroke or death rate of 14.7% in the PTAS group versus 5.8% in the medical management group (P = 0.002). Beyond 30 days, stroke rates were similar in both groups. The 1-year primary endpoint rate was 20.0% in the PTAS group and 12.2% in the medical management group. The high rate of periprocedural stroke in the PTAS group (14.7% within 30 days) and the lower rate of stroke in the medical management group (5.8%) indicated that aggressive medical therapy was more effective in preventing stroke. The trial also found that the risk of stroke in the medical management group was lower than expected, suggesting that aggressive medical therapy could be more effective than PTAS in this population. The study concluded that aggressive medical therapy was superior to PTAS in patients with intracranial arterial stenosis, as the risk of early stroke after PTAS was high and the risk of stroke with aggressive medical therapy alone was lower than expected. The trial was funded by the National Institute of Neurological Disorders and Stroke and others. The results highlight the importance of aggressive medical management in preventing stroke in patients with intracranial arterial stenosis.