title: Management of Symptomatic Intracranial Stenosis.
abstract: Intracranial atherosclerotic disease is a common cause of stroke worldwide, causing approximately 10 % of strokes in the USA and up to 50 % in Asian populations. Recurrent stroke risks are particularly high in those with a stenosis of 70 % or more and a recent transient ischemic attack or stroke. Warfarin has been associated with higher major hemorrhage rates and no reduction of recurrent stroke compared to aspirin in patients with symptomatic intracranial stenosis. After early trials showed the feasibility of stenting, two randomized trials compared stenting plus medical management to medical management alone in symptomatic intracranial stenosis. Stenting was linked with increased risk and showed no benefit in any subpopulation of patients. Aggressive medical management in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial was associated with half the risk of stroke compared to that in similar patients in a previous symptomatic intracranial stenosis trial after adjustment of confounding characteristics. Aggressive medical management comprises risk factor control, including a target systolic blood pressure <140 mmHg, a low density lipoprotein <70 mg/dL, hemoglobin A1C <7.0 %, and lifestyle management that incorporates exercise, smoking cessation and weight management, and the use of antithrombotics.
authors.affiliation: OHSU Stroke Center and Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Hoak
authors.affiliation: OHSU Stroke Center and Department of Neurology, Oregon Health & Science University, Portland, OR, USA. lutseph@ohsu.edu.|OHSU Stroke Center and Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, CR 131, Portland, OR, 97239, USA. lutseph@ohsu.edu.
authors.forename: Helmi L
authors.initials: HL
authors.lastname: Lutsep
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D019468:Disease Management; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000628:therapy*; D008019:Life Style; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
chemical_list: D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D000960:Hypolipidemic Agents
keywords: Intracranial stenosis; Ischemic stroke; Medical management; Stroke