Treatment of symptomatic intracranial atherosclerotic stenosis : a review

Abstract

Intracranial atherosclerotic stenosis (ICAS) is an important cause of ischemic stroke worldwide, accounting for 8-10% of strokes in North America and Europe and up to 50% in some Asian populations. Patients with symptomatic ICAS are at high risk of recurrent stroke, with rates up to 18% at 1 year despite medical therapy. This review discusses current evidence on prognosis, risk factors, and optimal medical and endovascular treatment for symptomatic ICAS. All patients should receive intensive medical therapy focused on antiplatelet agents, blood pressure control, cholesterol management, and lifestyle changes. Short-term dual antiplatelet therapy provides additional benefit for some patients. Endovascular stenting has not shown benefit over medical therapy in clinical trials and is not routinely recommended. However, selected patients who fail medical management may be considered for stenting or alternate endovascular approaches on an individual basis. Further research is critically needed to identify patients at highest risk of recurrence and evaluate novel therapies to improve outcomes. This review provides a framework for prognosis and management of symptomatic ICAS based on current evidence.