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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

Current management of symptomatic intracranial stenosis: medical versus endovascular therapy

John B Weigele1, Robert A Taylor, Scott E Kasner

  • 1Interventional Neuroradiology Service, Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA. john.weigele@uphs.upenn.edu

Current Atherosclerosis Reports
|January 5, 2008
PubMed

Insights

Intracranial arterial stenosis (IAS) causes 8-10% of ischemic strokes, with a high annual risk of recurrence. Current treatments focus on antiplatelet agents, reserving endovascular therapy for high-risk patients.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Interventional Cardiology

Background:

  • Intracranial arterial stenosis (IAS) accounts for 8-10% of ischemic strokes.
  • Patients with IAS face a significant 12% annual risk of recurrent stroke, particularly within the first year.
  • Warfarin offers no advantage over aspirin for stroke prevention in IAS and increases bleeding risks.

Purpose of the Study:

  • To review the current understanding of intracranial arterial stenosis (IAS).
  • To discuss the risks associated with IAS and current treatment strategies.
  • To highlight the evolving role of endovascular treatment for IAS.

Main Methods:

  • Literature review of studies on intracranial arterial stenosis.
  • Analysis of stroke recurrence rates and treatment outcomes.
  • Evaluation of antiplatelet therapy and endovascular interventions.

Main Results:

  • High-grade IAS (> or = 70%), recent symptom onset, and female sex are associated with the highest risk of recurrent stroke.
  • Antiplatelet agents are the recommended primary treatment for symptomatic IAS.
  • Endovascular therapy is considered for high-risk patients unresponsive to medical management.

Conclusions:

  • Symptomatic IAS presents a substantial risk of recurrent stroke.
  • Antiplatelet therapy is the cornerstone of medical management for IAS.
  • Endovascular treatment is an important therapeutic option for select high-risk IAS patients.

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