The case for angioplasty in patients with symptomatic intracranial atherosclerosis.

Ryan A Mctaggart,Michael P Marks

doi:10.3389/fneur.2014.00036

Abstract

Intracranial atherosclerotic disease (ICAD) is likely the most common cause of stroke worldwide and remains highly morbid even with highly monitored medical therapy. Recent results of the SAMMPRIS trial, which randomized patients to stenting plus aggressive medical management versus aggressive medical management alone have shown that additional treatment of intracranial atherosclerotic lesions with the Wingspan stent is inferior to aggressive medical management alone. In light of these results, there has been renewed interest in angioplasty alone to treat symptomatic ICAD. This article will briefly review the natural history of ICAD and discuss the possible future for endovascular treatment of ICAD with primary intracranial angioplasty in appropriately selected patients.

Highlights

Intracranial atherosclerotic disease (ICAD) is likely the most common cause of stroke worldwide and remains highly morbid even with highly monitored medical therapy
Mortality rates at 100 days were highest in the basilar artery occlusion group (44.7%) and were and 10.1 and 21.4% in the symptomatic intracranial atherosclerosis (>50%) and middle cerebral artery occlusion groups, respectively
While some medical subgroup data suggesting 7–8% stroke rates in untreated patients with symptomatic stenosis are available from the 1980s [11], the data are limited by selection bias and inadequate followup

Summary

Introduction

Intracranial atherosclerotic disease (ICAD) is likely the most common cause of stroke worldwide and remains highly morbid even with highly monitored medical therapy. Another subgroup analyses [15, 16] germane to the construction of SAMMPRIS was the identification of elevated blood pressure and cholesterol levels as predictive of future stroke and other vascular events in symptomatic patients with intracranial stenosis and were the basis of the aggressive medical management used for both arms of SAMPRISS. The SAMMPRIS trial [4] randomized patients with symptomatic intracranial stenosis (≥70%) to aggressive medical management versus endovascular therapy with aggressive medical www.frontiersin.org

Results

Conclusion