Intracranial atherosclerotic disease: an update.
The consensus conference on intracranial atherosclerosis provides a comprehensive review of the existing literature relevant to the epidemiology, diagnosis, prevention, and treatment of intracranial atherosclerosis, and identifies principles of management and research priorities. Patients who have suffered a stroke or transient ischemic attack attributed to stenosis (50-99%) of a major intracranial artery face a 12 to 14% risk for subsequent stroke during the 2-year period after the initial ischemic event, despite treatment with antithrombotic medications. The annual risk for subsequent stroke may exceed 20% in high-risk groups. In patients with intracranial atherosclerotic disease, short-term and long-term anticoagulation is not superior to antiplatelet treatment. Overall, the subgroup analyses from randomized trials provide evidence about benefit of aggressive atherogenic risk factor management. Intracranial angioplasty with or without stent placement has evolved as a therapeutic option for patients with symptomatic intracranial atherosclerotic disease, particularly those with high-grade stenosis with recurrent ischemic symptoms, medication failure, or both. A multicenter randomized trial is currently under way to compare stent placement with intense medical management for patients with high-grade symptomatic intracranial atherosclerotic disease.
Qureshi
Adnan I
AI
Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN 55455, USA. qureshi@umn.edu
Feldmann
Edward
E
Gomez
Camilo R
CR
Johnston
S Claiborne
SC
Kasner
Scott E
SE
Quick
Donald C
DC
Rasmussen
Peter A
PA
Suri
M Fareed K
MF
Taylor
Robert A
RA
Zaidat
Osama O
OO
D017130:Angioplasty / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use; D003245:Consensus Statements as Topic; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors