title: Spanning from the West to East: An Updated Review on Endovascular Treatment of Intracranial Atherosclerotic Disease.
abstract: Ischemic stroke is a major cause of morbidity and mortality, incurring significant cost. Intracranial atherosclerotic disease (ICAD) accounts for 10-15% of ischemic stroke in Western societies, but is an underlying pathology in up to 54% of ischemic strokes in Asian populations. ICAD has largely been treated with medical management, although a few studies have examined outcomes following endovascular treatment. Our objective was to summarize the major trials that have been performed thus far in regard to the endovascular treatment of ICAD and to provide direction for future management of this disease process. Systematic review of the literature from 1966 to 2015, was conducted in regard to intracranial angioplasty and stenting. Studies were analyzed from PubMed, American Heart Association and Society of Neurointerventional Surgery databases. SAMMPRIS and VISSIT are the only randomized controlled trials from which Western guidelines of intracranial stenting have been derived, which have displayed the superiority of medical management. However, pooled reviews of smaller studies and other nonrandomized trials have shown better outcomes with endovascular therapy in select patient subsets, such as intracranial vertebrobasilar stenosis or in the presence of robust collaterals. Suboptimal cases, including longer lesions, bifurcations and significant tortuosity tend to fair better with medical management. Medical management has been shown to be more efficacious with less adverse outcomes than endovascular therapy. However, the majority of studies on endovascular management included a diverse patient population without ideal selection criteria, resulting in higher adverse outcomes. Population analyses and selective utilization of endovascular therapy have shown that the treatment may be superior to other management in select patients.
authors.affiliation: 1Department of Neurology, University of Connecticut, Farmington, CT 06030, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hussain
authors.affiliation: 1Department of Neurology, University of Connecticut, Farmington, CT 06030, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Datta
authors.affiliation: 2Department of Neurology, Luhe Hospital, Capital Medical University, Beijing 101149, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Cheng
authors.affiliation: 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, OH 43210, USA.
authors.forename: David
authors.initials: D
authors.lastname: Dornbos
authors.affiliation: 4Department of Neurosurgery, Seton Hall University, South Orange, NJ 07079, USA.
authors.forename: Asif
authors.initials: A
authors.lastname: Bashir
authors.affiliation: 5Department of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Sultan
authors.affiliation: 1Department of Neurology, University of Connecticut, Farmington, CT 06030, USA.
authors.forename: Tapan
authors.initials: T
authors.lastname: Mehta
authors.affiliation: 6Department of Surgery, University of Arizona, Tucson, AZ 85724, USA.
authors.forename: Faris
authors.initials: F
authors.lastname: Shweikeh
authors.affiliation: 1Department of Neurology, University of Connecticut, Farmington, CT 06030, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Mazaris
authors.affiliation: 1Department of Neurology, University of Connecticut, Farmington, CT 06030, USA.
authors.forename: Nora
authors.initials: N
authors.lastname: Lee
authors.affiliation: 1Department of Neurology, University of Connecticut, Farmington, CT 06030, USA.
authors.forename: Amre
authors.initials: A
authors.lastname: Nouh
authors.affiliation: 2Department of Neurology, Luhe Hospital, Capital Medical University, Beijing 101149, China; 7Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48236, USA.
authors.forename: Xiaokun
authors.initials: X
authors.lastname: Geng
authors.affiliation: 7Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48236, USA.
authors.forename: Yuchuan
authors.initials: Y
authors.lastname: Ding
keywords: intracranial stenting; ischemic stroke; medical management in ICAD; randomized controlled trials