Evolution of intracranial atherosclerotic disease under modern medical therapy

Abstract

A majority of symptomatic high-grade intracranial plaques had regressed or remained quiescent by 12 months under intensive medical therapy. Artery-to-artery thromboembolism with impaired washout at border zones was a common mechanism in stroke recurrence.

Diagnostic and Therapeutic Strategies for Acute Intracranial Atherosclerosis-related Occlusions

“…The current best medical treatments, which are based on strong antiplatelet and intensive statin administration for ICAS, appear to lead to stenosis regression more often than expected, even without intervention. Around 80% of patients with ICAS have regression of the stenosis within 1 year of occlusion [36]. Therefore, dual antiplatelet and intensive statin treatment are necessary to prevent remnant ICAS stenosis after finishing ERT.…”

Ex-vivo imaging and plaque type classification of intracranial atherosclerotic plaque using high resolution MRI

“…Nevertheless, significant risks are incurred in stenting intracranial atherosclerotic lesions and no prospective trials have shown clear benefit to-date 3 . Medical management, however, appears promising with an angiographic study reporting the majority (79%) of stenosis regressing or remaining stable with aggressive medical management, although no definite clinical benefit was observed in this small study 26 . The ability of MRI to identify high-risk plaque features may be able to guide treatment selection as the benefits of each management approach become better understood.…”

Treatment and imaging of intracranial atherosclerotic stenosis: current perspectives and future directions

“…Currently, aggressive medical management remains the standard of care for patients with ICAS (Kernan et al, 2014). This is further supported by a recent study which showed that a majority of symptomatic high-grade intracranial plaques regress or remain quiescent by 1 year under intensive medical therapy (Leung et al, 2015).…”

“…Determining whether intracranial artery stenosis is symptomatic or asymptomatic may not be straightforward, since at least 19% of recurrent strokes in ICAS could have been caused by other coexisting mechanisms such as cardioembolism and extracranial large artery disease (Famakin, Chimowitz, Lynn, Stern, & George, ). Moreover, studies with microembolic signal monitoring by transcranial Doppler indicate that a combined embolism‐hypoperfusion mechanism could be common in symptomatic MCA stenosis (Leung et al., ; Wong et al., ). In a prospective study of 30 patients with symptomatic MCA stenosis, TCD monitoring showed microembolic signals in eight out of 16 patients with border zone infarcts (Wong et al., ).…”