Intracranial atherosclerotic disease: An update

Abstract

The consensus conference on intracranial atherosclerosis provides a comprehensive review of the existing literature relevant to the epidemiology, diagnosis, prevention, and treatment of intracranial atherosclerosis, and identifies principles of management and research priorities. Patients who have suffered a stroke or transient ischemic attack attributed to stenosis (50-99%) of a major intracranial artery face a 12 to 14% risk for subsequent stroke during the 2-year period after the initial ischemic event, despite treatment with antithrombotic medications. The annual risk for subsequent stroke may exceed 20% in high-risk groups. In patients with intracranial atherosclerotic disease, short-term and long-term anticoagulation is not superior to antiplatelet treatment. Overall, the subgroup analyses from randomized trials provide evidence about benefit of aggressive atherogenic risk factor management. Intracranial angioplasty with or without stent placement has evolved as a therapeutic option for patients with symptomatic intracranial atherosclerotic disease, particularly those with high-grade stenosis with recurrent ischemic symptoms, medication failure, or both. A multicenter randomized trial is currently under way to compare stent placement with intense medical management for patients with high-grade symptomatic intracranial atherosclerotic disease.

Intracranial-Derived Atherosclerosis Assessment: An In Vitro Comparison between Virtual Histology by Intravascular Ultrasonography, 7T MRI, and Histopathologic Findings

“…Preliminary data suggest the existence of a nonatherosclerotic variant involving the anterior circulation that may be prone to high rates of restenosis after stent treatment. 31,32 However, angiography is unable to differentiate nonatherosclerotic from atherosclerotic disease and assess the burden of fibrosis within plaque. Therefore, plaque differentiation may be valuable in assessing the risk-benefit ratio of medical and endovascular treatment options.…”

Collateral Circulation in Symptomatic Intracranial Atherosclerosis

“…Cases enrolled in the WASID trial were symptomatic with respect to a particular arterial lesion, but the role of multifocal disease may provide an opportunity to correlate collaterals with concomitant asymptomatic lesions, as well (Nahab et al, 2008). Perhaps most importantly, an initial description on the status of collaterals in intracranial stenosis may provide the framework for predictive modeling of future recurrent ischemic events and the relative impact of emerging therapies from medical regimens to interventional strategies with angioplasty and stenting (Qureshi et al, 2009).…”

Clinical Reasoning: A case of progressive cognitive decline reversed by middle cerebral artery stent placement

“…3 Other less common causes are primary angiitis of the CNS, a rare and poorly understood form of vascular inflammatory disease restricted to the brain and spinal cord, and secondary vasculitis of the CNS. These are a heterogeneous group of disorders characterized by blood vessel inflammation, producing different but frequently overlapping clinical manifestations.…”