Intracranial atherosclerotic disease: an update. Ann Neurol 2009 Dec;66(6):730-8
Date
12/26/2009Pubmed ID
20035502DOI
10.1002/ana.21768Scopus ID
2-s2.0-73549115369 (requires institutional sign-in at Scopus site) 94 CitationsAbstract
The consensus conference on intracranial atherosclerosis provides a comprehensive review of the existing literature relevant to the epidemiology, diagnosis, prevention, and treatment of intracranial atherosclerosis, and identifies principles of management and research priorities. Patients who have suffered a stroke or transient ischemic attack attributed to stenosis (50-99%) of a major intracranial artery face a 12 to 14% risk for subsequent stroke during the 2-year period after the initial ischemic event, despite treatment with antithrombotic medications. The annual risk for subsequent stroke may exceed 20% in high-risk groups. In patients with intracranial atherosclerotic disease, short-term and long-term anticoagulation is not superior to antiplatelet treatment. Overall, the subgroup analyses from randomized trials provide evidence about benefit of aggressive atherogenic risk factor management. Intracranial angioplasty with or without stent placement has evolved as a therapeutic option for patients with symptomatic intracranial atherosclerotic disease, particularly those with high-grade stenosis with recurrent ischemic symptoms, medication failure, or both. A multicenter randomized trial is currently under way to compare stent placement with intense medical management for patients with high-grade symptomatic intracranial atherosclerotic disease.
Author List
Qureshi AI, Feldmann E, Gomez CR, Johnston SC, Kasner SE, Quick DC, Rasmussen PA, Suri MF, Taylor RA, Zaidat OOMESH terms used to index this publication - Major topics in bold
AngioplastyAnticoagulants
Consensus Development Conferences as Topic
Humans
Intracranial Arteriosclerosis
Platelet Aggregation Inhibitors
Prevalence
Randomized Controlled Trials as Topic
Risk Factors
Thromboembolism
