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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Management of symptomatic intracranial atherosclerotic disease

Tudor G Jovin1, Rishi Gupta, Michael B Horowitz

  • 1University of Pittsburgh Medical Center, Stroke Institute, 200 Lothrop Street, Suite C-400, Pittsburgh, PA 15213, USA. jovintg@upmc.edu

Current Cardiology Reports
|March 17, 2007
PubMed

Insights

Symptomatic intracranial stenosis indicates aggressive vascular disease. While medical therapy is standard, high-risk patients may benefit from endovascular treatment, though further trials are needed.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Interventional Cardiology

Background:

  • Symptomatic intracranial stenosis is linked to a high risk of recurrent stroke (approx. 10% per year) and mortality.
  • It signifies aggressive vascular disease, often accompanied by comorbidities.
  • Medical management, including risk factor control and antiplatelet therapy, is the primary treatment.

Purpose of the Study:

  • To review medical treatment options for symptomatic intracranial stenosis.
  • To outline the current status of endovascular therapies for this condition.

Main Methods:

  • Review of prospective studies on symptomatic intracranial stenosis.
  • Analysis of medical treatment strategies.
  • Evaluation of endovascular treatment advancements (angioplasty and stenting).

Main Results:

  • Certain high-risk patients with severe stenosis (>70%) and hemodynamic impairment may not respond to medical therapy.
  • Advances in angioplasty and stenting technologies now allow for endovascular consideration in these refractory cases.
  • The comparative benefit of endovascular therapy versus medical therapy for high-risk patients remains to be established in randomized trials.

Conclusions:

  • Symptomatic intracranial stenosis requires aggressive management due to its association with poor outcomes.
  • Endovascular treatment is a potential option for select high-risk patients refractory to medical therapy.
  • Further randomized clinical trials are essential to establish the efficacy of endovascular interventions.

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