title: Early aggressive medical management for patients with symptomatic intracranial stenosis.
abstract: BACKGROUND
  There are limited data on the effect of an early aggressive risk factor modification program to achieve risk factor targets and its impact on clinical outcomes among patients with symptomatic intracranial stenosis.
  
  
  METHODS
  We prospectively identified patients with symptomatic intracranial stenosis of 50% to 99% (using computed tomographic angiography or cerebral angiography) who failed to qualify for or declined to participate in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis trial but elected to receive aggressive medical management. Aggressive medical management was defined as aspirin plus clopidogrel therapy for a minimum of 3 months, blood pressure control, statin use with a low-density lipoprotein (LDL) goal of <70 mg/dL, smoking cessation, and body mass index <25 kg/m(2).
  
  
  RESULTS
  Of 22 patients, the mean age was 65.6 ± 7.7 years, 82% were male, 59% were white, and mean percent stenosis was 71.5 ± 9.5% (55% with 70% to 99% stenosis). Median time from symptomatic event to first evaluation was 3 days. All patients completed 3 months of dual antiplatelet therapy, and at last follow-up, 86% had met their blood pressure goal, all were on statin therapy although only 73% had met their LDL goal, 96% reported no active tobacco use, and 36% had lost weight, but only 23% had achieved the BMI target. Over a mean follow-up of 1.2 years, there was no ischemic stroke, brain hemorrhage, or death from other vascular causes.
  
  
  CONCLUSIONS
  An early aggressive risk factor modification program achieved high levels of blood pressure and cholesterol targets for patients with symptomatic intracranial stenosis and when combined with dual antiplatelet therapy was effective for the prevention of recurrent vascular events in this cohort.
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA 30322, USA. fnahab@emory.edu
authors.forename: Fadi
authors.initials: F
authors.lastname: Nahab
authors.forename: Carlene
authors.initials: C
authors.lastname: Kingston
authors.forename: Michael R
authors.initials: MR
authors.lastname: Frankel
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Dion
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cawley
authors.forename: Brian
authors.initials: B
authors.lastname: Mitchell
authors.forename: L Paige
authors.initials: LP
authors.lastname: Hammonds
authors.forename: Lauren
authors.initials: L
authors.lastname: Ayala
authors.forename: Frank C
authors.initials: FC
authors.lastname: Tong
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D002533:Cerebral Angiography / Q000379:methods; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D002537:Intracranial Arteriosclerosis / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016540:Smoking Cessation; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin