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Randomized Secondary Prevention Trials in Participants With Symptomatic Intracranial Atherosclerotic Stenosis
Lauren E Dunn1, Yan Wang2, Tareq Kass-Hout3
1Department of Neurology, Ochsner Health System, New Orleans, LA (L.E.D.).
Insights
Intracranial atherosclerotic stenosis, a major cause of ischemic stroke, has high recurrence rates. This review examines secondary stroke prevention trials for better management strategies.
Area of Science:
- Neurology
- Cardiovascular Research
- Stroke Medicine
Background:
- Intracranial atherosclerotic stenosis (ICAS) is a leading global cause of ischemic stroke.
- ICAS is linked to silent cerebral infarcts, cognitive decline, and dementia.
- Despite advancements, ICAS patients face higher recurrent stroke rates than other stroke etiologies.
Purpose of the Study:
- To review randomized secondary prevention trials for intracranial atherosclerotic stenosis.
- To analyze findings from antithrombotic therapy, endovascular procedures, surgery, and remote ischemic conditioning.
- To inform future research directions in managing ICAS.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) on secondary stroke prevention in ICAS.
- Analysis of trials evaluating antithrombotic agents.
- Evaluation of studies on endovascular therapies, open surgical interventions, and remote ischemic conditioning.
Main Results:
- Antithrombotic therapy shows variable efficacy in preventing recurrent strokes in ICAS.
- Endovascular treatment and open surgical options present specific risk-benefit profiles.
- Remote ischemic conditioning is an emerging area with preliminary findings.
Conclusions:
- Evidence from secondary prevention trials guides current management of ICAS.
- Further research is needed to optimize treatment strategies and reduce stroke recurrence.
- Personalized approaches considering trial outcomes are crucial for ICAS patients.
Abstract:
Intracranial atherosclerotic stenosis is a prevalent cause of ischemic stroke worldwide. Its association with silent cerebral infarcts and its contribution to cognitive impairment and dementia emphasize the critical need for disease prevention and effective management strategies. Despite extensive research on secondary stroke prevention treatment over the past several decades, intracranial atherosclerotic stenosis continues to exhibit a notably higher recurrent stroke rate compared with other causes. This review focuses on randomized secondary prevention trials involving antithrombotic therapy, endovascular treatment, open surgical therapy, and remote ischemic conditioning. It aims to provide an insightful overview of the major findings from each trial and their implications for future research efforts.
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