Practical approach to management of intracranial atherosclerosis

Area of Science:

• Neurology
• Vascular Medicine
• Stroke Research

Background:

• Intracranial atherosclerosis (ICAS) is a major global cause of stroke with high recurrence rates.
• Therapeutic strategies for ICAS are continuously evolving.
• Identifying high-risk patient subsets remains a challenge.

Purpose of the Study:

• To review current therapeutic approaches for intracranial atherosclerosis.
• To highlight the limitations of existing treatments.
• To emphasize the need for novel treatment strategies.

Main Methods:

• Review of current evidence-based guidelines for ICAS management.
• Discussion of the role of medical management, including antiplatelet therapy.
• Evaluation of endovascular and investigational surgical options.

Main Results:

• Aggressive medical management with risk factor control and short-term dual antiplatelet therapy (90 days) followed by monotherapy is the current standard.
• Endovascular therapy is reserved for medically refractory cases with recurrent events.
• Investigational treatments like encephaloduroarteriosynagiosis (EDAS) show potential but require further study.

Conclusions:

• Despite optimal medical management, a subset of severe ICAS patients experience recurrent ischemic events.
• Novel treatments are necessary to prevent further stroke and death in high-risk ICAS patients.
• Further research is crucial for identifying high-risk individuals and developing innovative therapies.