Symptomatic Intracranial Atherosclerotic Disease

Standard of practice: endovascular treatment of intracranial atherosclerosis: Table 1

“…It is also important to address other atherosclerotic risk factors, including hypertension, hyperlipidemia, diabetes, smoking, diet and sedentary lifestyle. In the WASID trial, very few patients reached target blood pressure and low density lipoprotein (LDL) values (50% of patients had systolic blood pressure (SBP) >140 mm Hg and 58% had LDL >100 mg/dl) 41. While modification of vascular risk factors in stroke patients has been shown to reduce subsequent stroke risk, making this an extremely important aspect of management,42–44 the proportion of patients with symptomatic ICAD in these larger stroke studies is unknown and likely small.…”

Interventional Management of Intracranial Stenosis

“…An interesting comparison has been made regarding complication and event rates between balloon-mounted and self-expanding stents. The higher rate of periprocedural complication with balloon-mounted stents (7-10%) with a lower rate of long-term recurrent events at follow-up (2.9-3.7%) when compared to self-expanding stents (6.4% periprocedural complication and 10.3% long-term event rates) may suggest an increased risk of periprocedural events in balloon-mounted stents but decreased delayed events compared to self-expanding stents [49].…”

Quantitative Magnetic Resonance Angiography

“…Patients are being increasingly treated for symptomatic intracranial atherosclerotic disease. 2 Because this is a new technique, and restenosis is a problem as yet unquantified in sufficient numbers of patients, all patients routinely undergo follow-up angiography with, I am sure, an undoubted morbidity. Most proposed registries and trials also specify follow-up with conventional digital subtraction angiography.…”