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(Stroke. 2007;38:2391.)
© 2007 American Heart Association, Inc.

Topical Reviews

Emerging Endovascular Therapies for Symptomatic Intracranial Atherosclerotic Disease

David Fiorella, MD, PhD Henry H. Woo, MD

From the Cleveland Clinic (D.F.), Cleveland, Ohio; and the Department of Endovascular and Cerebrovascular Neurosurgery (H.H.W.), State University of New York at Stony Brook, Stony Brook, NY.

Correspondence to David Fiorella, MD PhD, Cleveland Clinic, 9500 Euclid Avenue, S80, Cleveland, Ohio 44195. E-mail fioreld@ccf.org

Marc Fisher MD Section Editor

Key Words: angioplasty • drug eluting stent • intracranial atherosclerosis • stent • wingspan stent

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

Over the past 2 decades there has been an exponential growth in the scope of disease processes amenable to neuroendovascular treatment. The number and sophistication of the available devices and correspondingly the number of patients undergoing treatment has expanded accordingly. The development and implementation of these new procedures has in some cases outpaced our ability to carefully assess their merits. In comparison to peripheral and coronary vascular disease, neurovascular lesions are less common and far more heterogeneous, ranging from acquired cerebrovascular ischemic disease to hemorrhagic congenital arteriovenous malformations. Each individual disease process (eg, cerebral aneurysm) is composed of a myriad of lesions with different anatomical and pathophysiological characteristics. The natural history of these lesions and their subtypes are likewise poorly defined. For these reasons, personal bias, institutional custom, and anecdotal experience rather than scientific evidence have played a dominant role in guiding therapy. We must move toward collaborative multi-center efforts, prospective data collection and well designed randomized controlled trials to mature as a field over the coming decades.

In some ways, symptomatic intracranial atherosclerotic disease (SxICAD) represents an optimal disease process with which to establish this progress toward evidenced based treatment. SxICAD is considerably less heterogeneous than other cerebrovascular disease processes and is arguably best suited as a paradigm for study.

In the current article we have attempted to review the available evidence describing the natural history of medically treated SxICAD to determine those patients best suited for invasive treatment strategies. We will also discuss the available treatment modalities which . . . [Full Text of this Article]

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