The evolving paradigm in the management of intracranial atherosclerotic disease

Area of Science:

• Neurology
• Vascular Surgery
• Neurosurgery

Background:

• Intracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke globally.
• The understanding of ICAD pathogenesis and natural history is limited, lacking established treatment protocols.
• Aspirin therapy, the current standard, often fails to prevent recurrent strokes in ICAD patients.

Purpose of the Study:

• To review the English literature on treatment options for ICAD.
• To present evidence-based data comparing surgical and endovascular interventions with medical therapy alone for ICAD.

Main Methods:

• Conducted a PubMed literature review.
• Focused on English-language publications concerning ICAD treatment strategies.
• Analyzed evidence regarding surgery, stenting, and medical management for ICAD.

Main Results:

• Current medical therapy, primarily aspirin, has limitations in preventing recurrent strokes in ICAD patients.
• Surgical and endovascular techniques like bypass and stenting are being re-evaluated for ICAD treatment.
• Evidence supports the consideration of surgical and stenting interventions alongside medical therapy.

Conclusions:

• ICAD remains a significant cause of ischemic stroke with unmet treatment needs.
• Further research and clinical evaluation are needed to define the optimal role of surgery and stenting in ICAD management.
• A multi-modal approach may be necessary for effective ICAD treatment.