Intracranial atherosclerotic disease; current options for surgical or medical treatment

Area of Science:

• Neurology
• Vascular Medicine
• Interventional Cardiology

Background:

• Intracranial atherosclerosis is an increasing cause of ischemic stroke, with higher prevalence in Korean populations compared to Caucasians.
• This condition frequently recurs, even with anti-platelet therapy, leading to potentially irreversible ischemic stroke deficits.
• Aggressive interventions are often necessary due to the limitations of medical management.

Purpose of the Study:

• To review the current therapeutic landscape for intracranial atherosclerosis.
• To highlight the need for further research, particularly randomized controlled trials, for advanced treatment modalities.

Main Methods:

• Review of recent advancements in endovascular therapy, including intracranial stenting and drug-eluting stents.
• Discussion of the role and limitations of extracranial-intracranial (EC-IC) bypass surgery.
• Analysis of the current treatment strategies in the context of limited clinical evidence.

Main Results:

• Intracranial stenting and drug-eluting stents represent significant therapeutic advancements.
• EC-IC bypass surgery is currently reserved for hemodynamically compromised patients due to historical study outcomes.
• A lack of robust randomized controlled trials hinders definitive evidence-based recommendations for many interventions.

Conclusions:

• Mechanical recanalization and bypass surgery are key strategies for restoring blood flow in stenotic intracranial arteries.
• Development of novel pharmacotherapies to inhibit atherosclerosis progression, thrombus formation, and promote stenosis regression is crucial.
• Further high-quality clinical trials are essential to establish the efficacy of current and emerging treatments for intracranial atherosclerosis and ischemic stroke prevention.