title: Current management of symptomatic intracranial stenosis.
abstract: Intracranial arterial stenosis (IAS) is the cause of about 10% of all ischemic strokes in the United States, but may account for about 40% of strokes in some populations. After a stroke or transient ischemic attack due to IAS, patients face a 12% annual risk of recurrent stroke on medical therapy, with most strokes occurring in the first year. Warfarin is no better than aspirin in preventing recurrent strokes but poses a higher risk of serious bleeding and death. Groups with the highest risk of recurrent stroke are those with high-grade (≥ 70%) stenosis, those with recent symptom onset, those with symptoms precipitated by hemodynamic maneuvers, and women. Endovascular treatment of IAS is a rapidly evolving therapeutic option. Antiplatelet agents are currently recommended as the primary treatment for symptomatic IAS, with endovascular therapy reserved for appropriate high-risk cases refractory to medical therapy.
authors: Department of Neurology, University of Minnesota, Minneapolis, USA. rataylor@umn.edu
authors: Robert A
authors: RA
authors: Taylor
authors: John B
authors: JB
authors: Weigele
authors: Scott E
authors: SE
authors: Kasner
references: Arch Neurol. 2001 Oct;58(10):1690-2
references: 11594932
references: Stroke. 1995 Jan;26(1):14-20
references: 7839388
references: AJNR Am J Neuroradiol. 2005 Apr;26(4):869-74
references: 15814936
references: Neuroepidemiology. 2003 Mar-Apr;22(2):106-17
references: 12656117
references: Stroke. 2000 Jan;31(1):95-9
references: 10625722
references: J Neurosurg. 2005 Nov;103(5):794-804
references: 16304982
references: J Neurosurg. 1999 Sep;91(3):415-23
references: 10470816
references: Arch Neurol. 2001 Oct;58(10):1687-90
references: 11594931
references: N Engl J Med. 2001 Nov 15;345(20):1444-51
references: 11794192
references: Stroke. 2004 Jun;35(6):1388-92
references: 15105508
references: Neurosurgery. 2007 Sep;61(3):644-50; discussion 650-1
references: 17881980
references: Stroke. 2004 Jun;35(6):1375-80
references: 15131312
references: Curr Neurol Neurosci Rep. 2001 Jan;1(1):39-53
references: 11898499
references: AJNR Am J Neuroradiol. 2005 Jan;26(1):166-74
references: 15661721
references: Neurosurg Focus. 2003 Mar 15;14(3):e1
references: 15709718
references: Circulation. 2006 Jan 31;113(4):555-63
references: 16432056
references: Stroke. 1996 Nov;27(11):1974-80
references: 8898801
references: Neurosurgery. 2001 Jun;48(6):1215-21; discussion 1221-3
references: 11383722
references: Neuroradiology. 2005 Mar;47(3):222-8
references: 15912418
references: J Neurol Sci. 1996 Nov;143(1-2):1-13
references: 8981292
references: Stroke. 2005 Apr;36(4):782-6
references: 15746463
references: N Engl J Med. 1985 Nov 7;313(19):1191-200
references: 2865674
references: Lancet. 1996 Nov 16;348(9038):1329-39
references: 8918275
references: J Neurol Neurosurg Psychiatry. 2004 Jun;75(6):847-51
references: 15145998
references: Neurology. 1990 Oct;40(10):1541-5
references: 2215945
references: Stroke. 2005 Dec;36(12):e165-8
references: 16282539
references: N Engl J Med. 2006 Aug 10;355(6):549-59
references: 16899775
references: Stroke. 2008 Aug;39(8):2396-9
references: 18535283
references: Neurology. 1995 Aug;45(8):1488-93
references: 7644046
references: N Engl J Med. 2005 Mar 31;352(13):1305-16
references: 15800226
references: Stroke. 2007 Mar;38(3):881-7
references: 17290030
references: Eur J Radiol. 2005 Aug;55(2):231-6
references: 16036152
references: Neurology. 2008 Apr 22;70(17):1518-24
references: 18235078
references: JAMA. 2006 Apr 5;295(13):1556-65
references: 16533939
references: Mayo Clin Proc. 1976 Nov;51(11):677-92
references: 994550
references: Neurosurgery. 2006 Apr;58(4):595-601; discussion 595-601
references: 16575322
references: AJNR Am J Neuroradiol. 1984 Sep-Oct;5(5):644-5
references: 6237554
references: Stroke. 2008 Sep;39(9):2505-10
references: 18658032
references: Circulation. 1964 Nov;30:654-70
references: 14226164
references: Neurosurgery. 2008 Jul;63(1):23-7; discussion 27-8
references: 18728565
references: J Vasc Interv Radiol. 2005 Oct;16(10):1281-5
references: 16223717
references: Neurology. 2006 Oct 10;67(7):1275-8
references: 17030766
references: Neurosurgery. 2009 Dec;65(6):1024-33; discussion 1033-4
references: 19934961
references: Proc Staff Meet Mayo Clin. 1955 Mar 23;30(6):116-26
references: 14371745
references: Neurology. 2006 Apr 25;66(8):1187-91
references: 16636236
references: Neurosurgery. 2006 Nov;59(5):1044-51; discussion 1051
references: 17143239
references: Mayo Clin Proc. 1980 Nov;55(11):673-80
references: 7442321
references: Stroke. 2006 Apr;37(4):1016-20
references: 16497979
references: Circulation. 2006 Jun 20;113(24):2826-34
references: 16769916
references: Neurology. 2000 Aug 22;55(4):465-6
references: 10953174
references: AJNR Am J Neuroradiol. 2005 Jun-Jul;26(6):1381-8
references: 15956503