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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Epidemiology, diagnosis and management of intracranial atherosclerotic disease

Jiann-Shing Jeng1, Sung-Chun Tang, Hon-Man Liu

  • 1Department of Neurology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan. jsjeng@ntu.edu.tw

Expert Review of Cardiovascular Therapy
|October 13, 2010
PubMed

Insights

Intracranial atherosclerotic disease (ICAD) increases stroke risk, especially in certain ethnicities. Antiplatelet drugs are preferred over anticoagulants, while angioplasty/stenting shows promise but needs long-term data.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Interventional Cardiology

Background:

  • Intracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke, disproportionately affecting Asian, black, and Hispanic populations.
  • Key risk factors for ICAD include hypertension, diabetes mellitus, and metabolic syndrome, contributing to a significant annual stroke risk of 10–20% in patients.
  • High-grade stenosis (70–99%) in ICAD patients elevates stroke recurrence risk, necessitating effective secondary prevention strategies.

Purpose of the Study:

  • To review current understanding and treatment strategies for intracranial atherosclerotic disease (ICAD).
  • To evaluate the role of antiplatelet therapy and emerging endovascular interventions like angioplasty and stenting in managing ICAD.
  • To highlight the need for further research, particularly high-quality randomized trials, to establish long-term benefits of interventions.

Main Methods:

  • Review of existing literature on intracranial atherosclerotic disease (ICAD) epidemiology, risk factors, and clinical outcomes.
  • Analysis of current secondary prevention guidelines, focusing on antiplatelet versus anticoagulant therapy.
  • Assessment of the efficacy and safety of endovascular treatments, including angioplasty and stenting for ICAD.

Main Results:

  • Antiplatelet agents remain the primary medical treatment for ICAD, with limited evidence supporting anticoagulants.
  • Angioplasty and stenting demonstrate high technical success and low periprocedural complication rates as an alternative to medical management.
  • Moderate rates of in-stent restenosis and uncertain long-term benefits necessitate further investigation into endovascular approaches.

Conclusions:

  • Effective secondary prevention for symptomatic ICAD patients is crucial due to high stroke recurrence rates.
  • While angioplasty and stenting offer a promising alternative for ICAD, long-term outcomes and restenosis rates require further evaluation.
  • High-quality randomized controlled trials comparing endovascular therapy with best medical therapy are essential for definitive treatment guidelines in ICAD.

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