Symptomatic intracranial stenosis: best medical treatment vs. intracranial stenting.
OBJECTIVE
The high risk of stroke and death in patients with symptomatic intracranial stenosis despite medical therapy has spurred interest in endovascular treatment approaches.


RESULTS
Three stents have been designed for the treatment of intracranial stenosis, and two, the Wingspan and Neurolink Stent Systems, have been evaluated in single-arm trials. The trials and two prospective registries evaluating the Wingspan Stent System suggest that stenting is most likely to be beneficial in patients with the highest risk of stroke on medical therapy, namely those with 70-99% stenosis.


CONCLUSIONS
Randomized treatment trials comparing stenting with medical therapy in symptomatic intracranial stenosis need to target the patients at highest risk of recurrent vascular events on medical therapy. Such trials are in progress. Ongoing trials in Asia are also assessing medical therapies, including cilostazol, in patients with intracranial stenosis.
Lutsep
Helmi L
HL
Oregon Health and Science University and Oregon Stroke Center, Portland, Oregon 97239-3098, USA. lutseph@ohsu.edu
D000800:Angioplasty, Balloon; D050197:Atherosclerosis / Q000473:pathology / Q000628:therapy; D002560:Cerebrovascular Circulation; D002986:Clinical Trials as Topic; D003251:Constriction, Pathologic / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D006083:Graft Occlusion, Vascular; D006801:Humans; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects / Q000592:standards; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control; D014652:Vascular Diseases / Q000188:drug therapy / Q000473:pathology / Q000601:surgery