Current diagnosis and management of symptomatic intracranial atherosclerotic disease

Abstract

Purpose of review Intracranial atherosclerotic disease (IAD) is likely the most common cause of stroke world-wide, and is associated with a very high risk of recurrence. It results in cerebral ischemia due to a variety of mechanisms, including artery-to-artery embolism, hemodynamic failure and occlusion of penetrating arteries. New imaging modalities focused on physiological consequences of IAD have become available and recent treatment trials have been completed. Recent findings We review the traditional imaging modalities, emphasizing the advantages and limitations of each method, and discuss novel physiological approaches that interrogate physiological process to indicate specific mechanisms of ischemia. These allow deeper understanding of the pathophysiological processes that underlie IAD-related ischemia. The key findings of recent therapeutic trails are reviewed, including the landmark randomized studies showing advantage of antiplatelet agents and risk factor modification, and a significant risk of complications with endovascular approaches. Summary Current evidence argues for aggressive medical management and suggests caution with interventional treatments. We propose that mechanistic information will further refine the risk assessment of patients with IAD to offer targeted therapy.

Association Between Ambulatory Systolic Blood Pressure During the Day and Asymptomatic Intracranial Arterial Stenosis

“…The average (±SD) age was 60 (±12) years. The median (interquartile range) duration of hypertension was 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) years. In all participants, 127 (16.8%) had asymptomatic ICAS (64 with stenosis ≥50% and 82 with stenosis at ≥2 intracranial arteries).…”

“…Hypertension is a well-established risk factor for both ischemic and hemorrhagic forms of stroke, as well as for ICAS. [4][5][6][7][8][9] However, there are limited data on the significance of asymptomatic ICAS in patients with hypertension.…”

Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment

“…Symptomatic intracranial atherosclerotic stenosis (IAS) is one of the leading causes of ischemic stroke in China [1], and is associated with a high risk of stroke recurrence secondary to artery-to-artery embolism, hemodynamic failure, or occlusion of the involved vasculature [1,2]. The risk of stroke recurrence depends on the severity of the IAS.…”

High Frequency of Intracranial Arterial Stenosis and Cannabis Use in Ischaemic Stroke in the Young

“…IAS may be due to multiple mechanisms and causes such as the following: embolism recanalization, dissection, intracranial atherosclerosis, vasculitis, vasospasm, toxic and radiation vasculopathies, moyamoya syndrome and disease, and reversible cerebral vasoconstriction syndrome [29,30]. Determining the exact cause of IAS remains a challenge, even with multimodal imaging and repeat angiographies.…”