Abstract
Intracranial atherosclerotic disease (ICAD) is considered a major cause of recurrent cerebrovascular events. ICAD continues to be a disease without an effective method of reducing the risk of recurrent stroke and death, even with aggressive, highly monitored medical treatment. We reviewed data from three randomized controlled studies that published data comparing intracranial stenting vs. medical treatment for symptomatic severe-ICAD. Ethnic, demographic, clinical, and procedural differences were observed among the data from these trials that might influence their results. Future research should aim at establishing refined selection criteria that can identify high-risk ICAD patients who may benefit from intracranial stenting.
Highlights
Intracranial atherosclerotic disease (ICAD) is considered a major cause of recurrent stroke and transient ischemic attacks (TIAs) [1]
The optimal treatment for ICAD is a crucial issue in Stroke Medicine
Data from recent trials demonstrated that aggressive medical treatment and lifestyle modifications are better than endovascular treatment for stroke prevention in high-risk patients with ICAD [2, 3]
Summary
Intracranial atherosclerotic disease (ICAD) is considered a major cause of recurrent stroke and transient ischemic attacks (TIAs) [1]. The optimal treatment for ICAD is a crucial issue in Stroke Medicine. Data from recent trials demonstrated that aggressive medical treatment and lifestyle modifications are better than endovascular treatment for stroke prevention in high-risk patients with ICAD [2, 3]. The annual stroke risk in patients with intracranial atherosclerosis is still high even with aggressive, highly monitored medical management. Questions remain as to what Stroke physicians should do, if patients suffer ischaemic events in spite of optimal medical treatment? Is endovascular therapy a viable treatment option for a certain subgroup of ICAD patients who are not responding to optimal medical therapy? Questions remain as to what Stroke physicians should do, if patients suffer ischaemic events in spite of optimal medical treatment? Is endovascular therapy a viable treatment option for a certain subgroup of ICAD patients who are not responding to optimal medical therapy?
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