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The case for angioplasty in patients with symptomatic intracranial atherosclerosis

Ryan A McTaggart1, Michael P Marks2

  • 1Department of Radiology, Cleveland Clinic Florida , Weston, FL , USA ; Department of Neurosurgery, Cleveland Clinic Florida , Weston, FL , USA ; Cerebrovascular Center, Neurological Institute, Cleveland Clinic , Cleveland OH , USA.

Frontiers in Neurology
|May 1, 2014
PubMed

Insights

Intracranial atherosclerotic disease (ICAD) causes many strokes globally. Stenting plus aggressive medical management was found inferior to aggressive medical management alone for ICAD, renewing interest in angioplasty.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Interventional Cardiology

Background:

  • Intracranial atherosclerotic disease (ICAD) is a leading cause of stroke worldwide.
  • Despite medical therapy, ICAD carries significant morbidity.
  • The SAMMPRIS trial demonstrated stenting's inferiority to aggressive medical management for ICAD.

Purpose of the Study:

  • To review the natural history of intracranial atherosclerotic disease.
  • To discuss the potential role of endovascular treatments for symptomatic ICAD.
  • To explore primary intracranial angioplasty for select ICAD patients.

Main Methods:

  • Review of natural history data for ICAD.
  • Analysis of recent clinical trial outcomes (SAMMPRIS).
  • Discussion of endovascular treatment strategies for ICAD.

Main Results:

  • Aggressive medical management alone proved superior to stenting plus aggressive medical management in the SAMMPRIS trial.
  • These findings have prompted re-evaluation of endovascular options for ICAD.
  • Angioplasty alone is being reconsidered for symptomatic ICAD.

Conclusions:

  • Primary intracranial angioplasty may offer a future treatment for carefully selected ICAD patients.
  • Further research is needed to define the optimal role of angioplasty in ICAD management.
  • Endovascular strategies for ICAD require careful consideration post-SAMMPRIS.

Keywords:
angioplastyintracranial atherosclerosisintracranial stenosisstenosisstents

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