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Symptomatic intracranial stenosis: best medical treatment vs. intracranial stenting

Helmi L Lutsep1

  • 1Oregon Health and Science University and Oregon Stroke Center, Portland, Oregon 97239-3098, USA. lutseph@ohsu.edu

Current Opinion in Neurology
|January 22, 2009
PubMed

Insights

Endovascular stenting may benefit patients with severe symptomatic intracranial stenosis (70-99%) at high risk of stroke. Ongoing trials are evaluating stenting versus medical therapy for these patients.

Area of Science:

  • Neurology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Symptomatic intracranial stenosis poses a high risk of stroke and mortality.
  • Medical therapy alone has limitations in preventing vascular events.
  • Endovascular treatment is being explored as an alternative approach.

Purpose of the Study:

  • To review current endovascular treatment options for symptomatic intracranial stenosis.
  • To evaluate the efficacy and safety of stenting in this patient population.
  • To identify patient subgroups most likely to benefit from stenting.

Main Methods:

  • Review of clinical trials and prospective registries evaluating stent systems for intracranial stenosis.
  • Analysis of data from studies on Wingspan and Neurolink Stent Systems.
  • Assessment of ongoing randomized controlled trials comparing stenting with medical therapy.

Main Results:

  • Three stent designs exist for intracranial stenosis treatment.
  • Wingspan and Neurolink Stent Systems have undergone single-arm trials.
  • Evidence suggests stenting is most beneficial for patients with 70-99% stenosis at high risk of stroke.

Conclusions:

  • Randomized trials are needed to compare stenting with medical therapy in high-risk patients.
  • Ongoing trials are investigating optimal treatment strategies for symptomatic intracranial stenosis.
  • Further research is assessing medical therapies, including cilostazol, in managing intracranial stenosis.
Abstract

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