The Sykes-Picot Agreement (1916) BACKGROUND Secret agreement during WWI between {{c1::Britain}} and France (w/ Russian assent) to divide the Ottoman Empire's Arab provinces into spheres of influence after the war KEY TERMS Britain got control of areas roughly corresponding to modern {{c2::Iraq}} and Jordan France got control of areas roughly corresponding to modern Syria and Lebanon Palestine was designated for {{c3::international}} administration d/t competing claims Negotiated by British diplomat Mark Sykes and French diplomat François {{c4::Georges-Picot}} SIGNIFICANCE Directly contradicted promises made to Arab leaders (notably Sharif Hussein) who were fighting the Ottoman Empire in exchange for promised {{c5::independence}} Artificial borders drawn w/o regard to ethnic/religious/tribal lines — widely cited as root cause of ongoing Middle Eastern conflict

SAMMPRIS (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) DESIGN Multicenter RCT, 451 pts w/ recent (<30d) TIA or stroke d/t 70-99% intracranial atherosclerotic {{c1::stenosis}} Randomized to AMM alone vs AMM + PTAS w/ Wingspan stent AMM = dual antiplatelet (ASA + clopidogrel x 90d), intensive risk factor mgmt (SBP <140, LDL <70, lifestyle) PRIMARY OUTCOME Stroke or death within 30d, or ipsilateral stroke beyond 30d up to 32mo RESULTS 30-day stroke/death: {{c2::14.7}}% (PTAS+AMM) vs {{c3::5.8}}% (AMM alone), P=0.002 Trial stopped early by DSMB d/t safety + {{c4::futility}} Long-term f/u confirmed medical tx superiority SIGNIFICANCE Practice-changing: aggressive {{c5::medical}} management = standard of care for symptomatic ICAD Wingspan stenting carries unacceptable periprocedural risk Source: Chimowitz MI et al., NEJM 2011