Surgery and Neurointervention for Intracranial Atherosclerotic Steno-occlusive Disease

Abstract

Neurosurgeons and neurointerventionists interested in cerebral revascularization to prevent stroke from intracranial atherosclerotic stenoocclusive disease were disappointed in 2011 with the closure of two important negative studies: the Carotid Occlusion Surgery Study (COSS) and Stenting and Aggressive Medical Therapy for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study. Debates are centered on what causes these failures. While extracranial-intracranial (EC-IC) bypass and neurointervention (angioplasty and/or stenting) cannot be considered a routine intervention for patients presenting with initial ischemic event in the setting of atherosclerotic steno-occlusive disease, selected patients with severe hemodynamic impairment and/or recurrent symptoms despite maximal medical therapy may still benefit from surgery and neurointervention at high-volume centers, which can offer the procedure with low peri-operative morbidity.