Management of patients with symptomatic intracranial atherosclerosis

Area of Science:

• Neurology
• Vascular Medicine
• Interventional Cardiology

Background:

• Intracranial atherosclerosis (IAS) is a significant cause of ischemic stroke, particularly in Asia.
• Intracranial stenosis is an independent predictor of poor outcomes, including recurrent vascular events and mortality, even with antiplatelet therapy.

Purpose of the Study:

• To review the current literature on treatment strategies for symptomatic intracranial stenosis.
• To evaluate the efficacy of warfarin, dual antiplatelet therapy, and endovascular interventions for IAS.

Main Methods:

• Literature review of published studies on symptomatic intracranial stenosis treatment.
• Analysis of key clinical trials such as WASID and WARSS.
• Assessment of emerging endovascular technologies and ongoing randomized trials.

Main Results:

• Oral anticoagulation with warfarin did not demonstrate superiority over aspirin in managing IAS.
• Dual antiplatelet therapy showed promising results in halting stenosis progression.
• Endovascular intervention results are mixed, with technological advancements showing promise but lacking randomized controlled study data.

Conclusions:

• Established therapies for IAS remain limited, with current treatments showing insufficient efficacy.
• Ongoing trials investigating dual antiplatelet agents and endovascular interventions are crucial for future management strategies.
• Further evidence from randomized clinical trials is needed to guide optimal patient care for intracranial stenosis.