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(Stroke. 2008;39:1661.)
© 2008 American Heart Association, Inc.

Editorials

Symptomatic Intracranial Atherosclerotic Disease

What Is the Best Treatment Option?

Rishi Gupta, MD

From the Department of Neurology, Michigan State University, East Lansing, Mich.

Correspondence to Rishi Gupta, MD, Michigan State University, 138 Service Rd, A-217, East Lansing, MI 48824. E-mail Rishi.gupta@ht.msu.edu

Key Words: intracranial stenosis • stenting

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 1766–1769.

Symptomatic intracranial atherosclerotic disease carries a significant risk for future ipsilateral ischemic events regardless of the use of warfarin or aspirin.¹ Patients presenting with a lesion that is >70% appear to be most vulnerable with a 1-year risk of 23% for a subsequent ipsilateral event.² Moreover, poor control of blood pressure and cholesterol appear to be associated with a higher risk of a subsequent stroke. At 1-year follow-up in the WASID study, 58% of patients were still found to have a LDL cholesterol of >100 mg/dL despite 91% of patients being on lipid-lowering therapy, and 50% of patients were found to have a systolic blood pressure >140 mm Hg.³ Recent guidelines suggest that patients at high risk for vascular disease may benefit from LDL cholesterol levels below 70 mg/dL,⁴ which was achieved in only 12% of patients in the WASID study at 1-year follow-up.³ This has highlighted the importance of vascular neurologists being more aggressive with risk factor modification as stroke victims are at a high risk for future vascular events.⁵

Endovascular therapy with balloon angioplasty for symptomatic intracranial atherosclerosis was first reported over 2 decades ago.⁶ Since this report, there have been several single institution reports along with multicenter registries showing the feasibility of performing angioplasty and/or stenting for symptomatic intracranial atherosclerotic lesions. No consensus has been reached as to the best endovascular modality (ie, balloon mounted stents, self-expanding stents or balloon angioplasty) to treat this disease. Due to the cerebrovascular tortuosity, there . . . [Full Text of this Article]

Related Article:

Durability of Endovascular Therapy for Symptomatic Intracranial Atherosclerosis

Mikael Mazighi, Jay S. Yadav, and Alex Abou-Chebl
Stroke 2008 39: 1766-1769. [Abstract] [Full Text] [PDF]

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