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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Current management of symptomatic intracranial stenosis

Robert A Taylor1, John B Weigele, Scott E Kasner

  • 1Department of Neurology, University of Minnesota, Minneapolis, USA. rataylor@umn.edu

Current Atherosclerosis Reports
|May 21, 2011
PubMed

Insights

Intracranial arterial stenosis (IAS) causes strokes, with a high annual risk of recurrence on medical therapy. Endovascular treatment is an option for high-risk patients refractory to antiplatelet agents.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Stroke Research

Background:

  • Intracranial arterial stenosis (IAS) contributes significantly to ischemic strokes, particularly in specific populations.
  • Patients with IAS face a substantial annual risk of recurrent stroke, with most events occurring within the first year post-event.
  • Warfarin offers no advantage over aspirin for preventing recurrent strokes and increases bleeding risks.

Purpose of the Study:

  • To review the epidemiology, risk factors, and current treatment strategies for intracranial arterial stenosis.
  • To evaluate the role of antiplatelet agents and endovascular therapy in managing symptomatic IAS.
  • To identify patient groups at highest risk for recurrent stroke due to IAS.

Main Methods:

  • Literature review of studies on intracranial arterial stenosis and ischemic stroke.
  • Analysis of risk factors associated with recurrent stroke in IAS patients.
  • Evaluation of comparative effectiveness of medical versus endovascular treatments.

Main Results:

  • IAS accounts for a notable percentage of ischemic strokes, with higher prevalence in certain demographics.
  • High-grade stenosis (≥70%), recent symptom onset, hemodynamic triggers, and female sex are associated with increased recurrent stroke risk.
  • Antiplatelet agents are standard medical therapy; endovascular therapy is reserved for refractory high-risk cases.

Conclusions:

  • Symptomatic IAS presents a significant risk for recurrent stroke, necessitating effective management strategies.
  • Risk stratification is crucial for identifying patients who may benefit from advanced interventions.
  • Current guidelines recommend antiplatelet therapy, with endovascular options for select high-risk individuals.

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