Treatment of intracranial arterial stenosis.
Intracranial stenosis accounts for 8-10% of ischemic strokes in the USA. Treatment of intracranial stenosis with extracranial-to-intracranial bypass surgery was investigated as a therapy in the 1980s, but was shown to be no better than aspirin alone. The Warfarin vs Aspirin for Symptomatic Intracranial Disease study found a 12% per year risk of recurrent stroke for symptomatic lesions of 50% or higher, with the majority of strokes occurring in the first year. Warfarin was no better than aspirin in the prevention of recurrent stroke and had a higher risk of serious bleeding and death. Subgroup analysis showed that patients with the highest risk of recurrent stroke included those with 70% or more stenosis and/or recent symptoms and women. Angioplasty and stenting of intracranial stenosis have been undergoing rapid evolution in technology and are emerging as a promising therapy. Current treatment recommendations include antiplatelet agents, with consideration for angioplasty alone or angioplasty and stenting in cases refractory to medical therapy.
Taylor
Robert A
RA
Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242-1077, USA. robert-taylor@uiowa.edu
Kasner
Scott E
SE
D017130:Angioplasty / Q000295:instrumentation / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use*; D001807:Blood Vessel Prosthesis; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000628:therapy*; D008954:Models, Biological; D009363:Neoplasm Proteins / Q000378:metabolism*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015607:Stents
D000925:Anticoagulants; D009363:Neoplasm Proteins