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.

Insights

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.

Related Concept Videos

Transient Ischemic Attack l: Introduction01:26

Transient Ischemic Attack l: Introduction

A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
Atherosclerosis II: Clinical Manifestations and Diagnostic Tests01:27

Atherosclerosis II: Clinical Manifestations and Diagnostic Tests

Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
Atherosclerosis I: Introduction01:30

Atherosclerosis I: Introduction

Atherosclerosis is a progressive disorder characterized by the buildup of plaques on the arterial inner wall, causing them to narrow and harden over time. These plaques comprise lipids, calcium, blood components, carbohydrates, and fibrous tissue. The process primarily affects the intima of large and medium-sized arteries, reducing blood flow in any artery.Etiology and risk factorsThe cause of atherosclerosis is multifactorial, involving a complex interplay among endothelial injury, lipid...
Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Peripheral Artery Disease I: Introduction01:30

Peripheral Artery Disease I: Introduction

Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs, particularly the arteries supplying the thighs and calves. In rare cases, it may involve other arteries, including those in the arms.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty...