Intracranial atherosclerotic disease
Robert A Taylor1, Adnan I Qureshi
1Robert A. Taylor, MD Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware Street SE, Minneapolis, MN 55455, USA. rataylor@umn.edu.
Current Treatment Options in Neurology
|November 7, 2009
Summary
Symptomatic intracranial arterial stenosis has high recurrent stroke risk. Lifestyle changes and medications are key, while endovascular treatments like angioplasty with stenting are under investigation for severe cases.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Interventional Neuroradiology
Background:
- Symptomatic intracranial arterial stenosis presents a significant risk of recurrent stroke, with annual rates ranging from 10% to 20% even with antithrombotic therapy.
- Current management focuses on secondary stroke prevention targeting atherogenic risk factors.
Purpose of the Study:
- To outline current stroke prevention strategies for intracranial atherosclerotic disease.
- To discuss pharmacologic treatments and lifestyle modifications.
- To review the status and considerations for endovascular interventions like angioplasty with stent placement.
Main Methods:
- Review of established secondary stroke prevention guidelines.
- Discussion of pharmacologic interventions including antiplatelet agents, statins, glycemic control, and antihypertensives.
- Evaluation of endovascular treatment options, specifically angioplasty with stent placement, for severe symptomatic intracranial stenosis.
Main Results:
- Standard guidelines recommend lifestyle modifications (weight loss, exercise, smoking cessation, diet) and pharmacologic treatments.
- Therapeutic goals include specific low-density lipoprotein cholesterol levels and modest blood pressure reduction.
- Angioplasty with stent placement is under evaluation for severe stenosis; its superiority over angioplasty alone is uncertain, and its use is limited to clinical trials due to variable outcomes.
Conclusions:
- Comprehensive management of intracranial arterial stenosis involves aggressive risk factor modification and pharmacotherapy.
- Endovascular procedures like angioplasty with stenting are promising but require further evaluation in randomized controlled trials before widespread adoption.
- Current recommendations emphasize caution regarding the broad application of intracranial angioplasty and stenting outside specialized centers and trials.
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