The SAMMPRIS trial (N=451) used the Wingspan stenting system; the VISSIT trial (Vitesse Intracranial Stent Study for Ischemic Stroke Therapy; N=112) used the Pharos system; and a single-center RCT in China (N=70) allowed either Wingspan or Coroflex stenting systems. Medical therapy was similar in the 3 RCTs and consisted of risk factor management and combination aspirin and clopidogrel for 90 days and then aspirin alone. All 3 RCTs showed a higher 30-day rate of cere- brovascular events or death in the PTAS group than the medical group and no benefit of PTAS beyond the periprocedural period.353 355 Post hoc analyses of SAMMPRIS baseline characteristics failed to demonstrate any subgroup of patients who ben- efited from PTAS but did identify some possible high-risk features for future study.356,357 Two other RCTs (VAST [Vertebral Artery Stenting Trial] and VIST [Vertebral Artery Ischemic Stenting Trial]) that randomized patients with intracranial and extracra- nial posterior circulation stenosis to PTAS or medi- cal therapy reported no significant benefit of PTAS among the patients with ICAS.358,359 9. No RCTs have directly compared PTAS with med- ical therapy in patients with symptomatic 50% to 69% stenosis. However, the low rate of stroke on medical therapy in patients with 50% to 69% high periprocedural risk, which does not vary by degree of stenosis,368 and lack of demonstrated benefit of PTAS in well-designed RCTs performed in a higher-risk population do not support the use of PTAS. 10. 