Management of patients with symptomatic intracranial atherosclerosis

International Journal of Stroke : Official Journal of the International Stroke Society
Thomas W LeungKa Sing Wong

Abstract

Intracranial atherosclerosis is a common cause of stroke, accounting for about 50% of ischaemic stroke in Asia and 8% in North America. Many prospective studies have confirmed that intracranial stenosis is an independent predictor for poor outcomes such as recurrent vascular event and death, despite the use of antiplatelet agents. The annual event rate is about 15% per year. The dismal outcome prompts the study of more aggressive treatment strategies, including warfarin and endovascular intervention. We have reviewed the published literature for the treatment of symptomatic intracranial stenosis. The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial and Warfarin-Aspirin Recurrent Stroke Study (WARSS) studies failed to show that oral anticoagulation was better than aspirin in IAS. Initial encouraging results were found in the use of dual antiplatelet therapy in arresting the progression of stenosis. The results of the endovascular studies are mixed: there are more encouraging results with recent advances of technology in stent design, but a randomized controlled study is still lacking. Although there is still no established therapy for IAS, the results of ongoing randomized clinical trials to study dual antiplatele...Continue Reading

References

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Citations

Feb 19, 2009·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·D A De SilvaC Chen
May 2, 2009·Stroke; a Journal of Cerebral Circulation·Tanya N TuranMarc I Chimowitz
Jun 1, 2010·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Xiao-Yu ZhouBernard Yan
Jul 14, 2009·Medicina clínica·Francisco PurroyMaria Isabel Gil
Oct 28, 2010·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·Andrei V AlexandrovUNKNOWN American Society of Neuroimaging Practice Guidelines Committee
Jan 6, 2015·Annals of Neurology·Thomas W LeungSimon C H Yu
Dec 11, 2013·Journal of Stroke·Kazunori Toyoda
Jun 13, 2015·Molekuliarnaia biologiia·B V TitovO O Favorova
Oct 19, 2017·Journal of Stroke·Jong S Kim, Oh Young Bang
Dec 17, 2010·World Journal of Radiology·Ricardo J KomotarPhilip M Meyers
Feb 10, 2021·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Dorin HarpazRaymond C S Seet

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Methods Mentioned

BETA
imaging techniques
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