Intracranial Atherosclerotic Stenosis.

Area of Science:

• Neurology
• Cardiovascular Medicine
• Public Health

Background:

• Ischemic stroke is a leading cause of mortality and disability globally.
• Intracranial atherosclerotic stenosis (ICAS) is a primary cause of stroke, particularly in Asian populations, and is distinct from extracranial atherosclerotic stenosis (ECAS).
• Understanding ICAS mechanisms is critical for stroke prevention strategies in Asian demographics.

Purpose of the Study:

• To highlight the importance of differentiating ICAS from ECAS due to differing pathophysiologies.
• To emphasize the need for specific diagnostic and therapeutic approaches for ICAS.
• To outline current recommendations for stroke prevention in patients with ICAS.

Main Methods:

• Review of existing literature on ICAS and stroke.
• Analysis of diagnostic neuroimaging techniques, including high-resolution MRI (HR-MRI).
• Evaluation of current treatment strategies, including risk factor modification, antiplatelet therapies, and interventions.

Main Results:

• ICAS is a significant cause of ischemic stroke in Asians, necessitating distinct prevention strategies from ECAS.
• High-resolution MRI (HR-MRI) aids in differentiating ICAS etiologies.
• Short-term dual antiplatelet therapies (DAPT) for 90 days are recommended for symptomatic severe ICAS (70-99%).

Conclusions:

• Differentiating the etiology of intracranial artery stenosis is crucial, with HR-MRI being a valuable tool.
• Intensive management of modifiable risk factors and appropriate antiplatelet therapies are essential for stroke prevention in ICAS patients.
• Cilostazol is a potential second-line treatment, while surgical or endovascular interventions are reserved for specific severe cases.