Advances in imaging of intracranial atherosclerotic disease and implications for treatment

Area of Science:

• Neurology
• Vascular Neurology
• Cerebrovascular Disease

Background:

• Intracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke globally.
• Patients with ICAD face a significant risk of recurrent stroke, even with aggressive medical management.
• Current treatment strategies for ICAD have limitations, highlighting the need for improved approaches.

Purpose of the Study:

• To explore the mechanisms underlying cerebral ischemia in ICAD.
• To identify patient subsets who may not respond optimally to current medical interventions.
• To discuss potential alternative or refined therapeutic strategies for symptomatic ICAD.

Main Methods:

• Review of existing literature on ICAD and stroke mechanisms.
• Analysis of the implications of previous clinical trials, such as the SAMMPRIS study.
• Discussion of advancements in diagnostic testing for better patient stratification.

Main Results:

• ICAD can cause cerebral ischemia through various poorly understood mechanisms.
• Endovascular therapy in the SAMMPRIS study showed increased risks of stroke and death.
• Advances in diagnostics may allow for better identification of stroke mechanisms and high-risk patients.

Conclusions:

• Symptomatic ICAD remains a challenging condition with limited optimal treatment options.
• Personalized treatment approaches, potentially including targeted medical plaque stabilization or angioplasty alone, may benefit specific patient groups.
• Future clinical trials are necessary to evaluate these refined therapeutic strategies.