Treatment of intracranial arterial stenosis

Area of Science:

• Neurology
• Vascular Surgery

Background:

• Intracranial stenosis is a significant cause of ischemic stroke in the USA, accounting for 8-10% of cases.
• Previous treatments like extracranial-to-intracranial bypass surgery in the 1980s did not prove superior to aspirin alone.
• The Warfarin vs Aspirin for Symptomatic Intracranial Disease study highlighted a substantial annual risk of recurrent stroke (12%) for symptomatic stenosis of 50% or higher.

Purpose of the Study:

• To review the efficacy of various treatments for intracranial stenosis.
• To identify patient subgroups at highest risk for recurrent stroke.
• To evaluate the emerging role of endovascular therapies.

Main Methods:

• Review of historical treatment data, including bypass surgery and anticoagulant therapy (warfarin vs. aspirin).
• Analysis of findings from the Warfarin vs Aspirin for Symptomatic Intracranial Disease study.
• Assessment of current advancements in angioplasty and stenting for intracranial stenosis.

Main Results:

• Extracranial-to-intracranial bypass surgery was not more effective than aspirin.
• Warfarin offered no advantage over aspirin in preventing recurrent stroke and increased bleeding risks.
• Patients with $\ge$70% stenosis, recent symptoms, or female sex faced the highest recurrent stroke risk.

Conclusions:

• Medical management with antiplatelet agents is the current recommendation.
• Angioplasty and stenting are promising therapeutic options for medically refractory cases.
• Ongoing technological advancements are improving endovascular treatment outcomes for intracranial stenosis.