Abstract
Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke worldwide and represents a significant health problem. The pathogenesis and natural history of ICAD are poorly understood, and rigorous treatment paradigms do not exist as they do for extracranial atherosclerosis. Currently, the best treatment for ICAD remains aspirin therapy, but many patients who are placed on aspirin continue to experience recurrent strokes. As microsurgical and endovascular techniques continue to evolve, the role of extracranial to intracranial bypass operations and stenting are increasingly being reconsidered. We performed a PubMed review of the English literature with a particular focus on treatment options for ICAD and present evidence-based data for the role of surgery and stenting in ICAD against medical therapy alone.
Highlights
Intracranial atherosclerotic disease (ICAD) is the process by which atherosclerotic plaques affect large intracranial arteries
The results of the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study demonstrated the role for medical therapy in International Journal of Vascular Medicine
Patients presenting within 90 days of a transient ischemic attack (TIA) or nonsevere stroke attributable to angiographically proven high-grade (50– 99%) stenosis of a major intracranial artery were given either aspirin or warfarin and were followed for the primary endpoints of ischemic stroke, hemorrhagic stroke, and vascular death
Summary
Intracranial atherosclerotic disease (ICAD) is the process by which atherosclerotic plaques affect large intracranial arteries. Intracranial stenosis represents the most advanced stage of ICAD and is a precursor to ischemic stroke. ICAD is the leading cause of stroke among patients of Asian ancestry [1], and Hispanics and Africans appear to be more prone to [2] intracranial as opposed to extracranial atherosclerosis. On the other hand, are less affected, but ICAD is still thought to account for almost 10% of ischemic strokes in this subpopulation [3]. Worldwide, ICAD may be the leading the cause of ischemic stroke. The prevalence and natural history of asymptomatic ICAD are much less understood, in people of European descent
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