title: Intracranial arterial stenosis.
abstract: Intracranial arterial stenosis (IAS) is usually attributable to atherosclerosis and corresponds to the most common cause of stroke worldwide. It is very prevalent among African, Asian, and Hispanic populations. Advancing age, systolic hypertension, diabetes mellitus, high levels of low-density lipoprotein cholesterol, and metabolic syndrome are some of its major risk factors. IAS may be associated with transient or definite neurological symptoms or can be clinically asymptomatic. Transcranial Doppler and magnetic resonance angiography are the most frequently used ancillary examinations for screening and follow-up. Computed tomography angiography can either serve as a screening tool for the detection of IAS or increasingly as a confirmatory test approaching the diagnostic accuracy of catheter digital subtraction angiography, which is still considered the gold (confirmation) standard. The risk of stroke in patients with asymptomatic atherosclerotic IAS is low (up to 6% over a mean follow-up period of approximately 2 years), but the annual risk of stroke recurrence in the presence of a symptomatic stenosis may exceed 20% when the degree of luminal narrowing is 70% or more, recently after an ischemic event, and in women. It is a matter of controversy whether there is a specific type of treatment other than medical management (including aggressive control of vascular risk factors and antiplatelet therapy) that may alter the high risk of stroke recurrence among patients with symptomatic IAS. Endovascular treatment has been thought to be helpful in patients who fail to respond to medical treatment alone, but recent data contradict such expectation.
authors.affiliation: Department of Neurology, Hospital de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Marta
authors.initials: M
authors.lastname: Carvalho
authors.affiliation: Department of Neurology, Hospital de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Oliveira
authors.affiliation: Department of Neurology, Hospital de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Elsa
authors.initials: E
authors.lastname: Azevedo
authors.affiliation: Department of Medical Imaging, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: abastosleite@med.up.pt.
authors.forename: António J
authors.initials: AJ
authors.lastname: Bastos-Leite
mesh_terms: D002539:Cerebral Arterial Diseases / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D003251:Constriction, Pathologic; D006801:Humans; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
keywords: Atherosclerosis; epidemiology; intracranial arterial stenosis; management and treatment; middle cerebral artery stenosis; middle cerebral artery stroke; neuroimaging; pathophysiology; vascular risk factors