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The challenge of stroke prevention with intracranial arterial stenosis

Tanya N Turan1, Alison Smock, Marc I Chimowitz

  • 1MUSC Stroke Program, Suite 501, Harborview Office Tower, 19 Hagood Ave, Charleston, SC, 29425, USA, turan@musc.edu.

Current Cardiology Reports
|October 10, 2013
PubMed

Insights

Secondary prevention for symptomatic intracranial atherosclerotic disease is challenging. Aggressive risk factor management is the current standard, while endovascular and surgical options require further study.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Cardiovascular Research

Background:

  • Symptomatic intracranial atherosclerotic disease (ICAD) carries a high risk of recurrent stroke.
  • Secondary stroke prevention in ICAD patients presents significant clinical challenges.
  • Current treatment paradigms focus on managing vascular risk factors.

Purpose of the Study:

  • To review the current strategies for secondary prevention in patients with symptomatic ICAD.
  • To evaluate the established and emerging therapeutic options for ICAD.
  • To emphasize the importance of risk factor modification in managing ICAD.

Main Methods:

  • Literature review of studies on intracranial atherosclerotic disease.
  • Analysis of data regarding medical, endovascular, and surgical interventions.
  • Assessment of the safety and efficacy of aggressive vascular risk factor management.

Main Results:

  • Aggressive medical management of vascular risk factors is proven safe and effective for most high-risk ICAD patients.
  • The definitive roles of endovascular and surgical therapies in ICAD secondary prevention remain uncertain.
  • Risk factor control is the cornerstone of evidence-based treatment for ICAD.

Conclusions:

  • Aggressive risk factor control is the current mainstay of evidence-based treatment for symptomatic intracranial atherosclerotic disease.
  • Further research is needed to clarify the role of endovascular and surgical interventions.
  • Future studies may uncover novel therapeutic strategies for ICAD management.

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