Advances in imaging of intracranial atherosclerotic disease and implications for treatment

Fan Z. Caprio, Shyam Prabhakaran

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Opinion statement: Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke worldwide and is associated with a high risk of recurrent stroke despite aggressive therapy. ICAD may lead to cerebral ischemia through a variety of mechanisms, the interactions of which are largely unknown. The use of endovascular therapy for the prevention of stroke related to severe ICAD has been studied but was associated with a higher risk of recurrent stroke and death in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study. With advances in diagnostic testing, it may be possible to better delineate the specific mechanism of stroke from ICAD and identify those patients at higher risk for recurrent ischemia. There may be a subset of patients less responsive to medical interventions, such as those with hemodynamic failure as opposed to those with perforator syndromes, who would benefit from medical plaque stabilization or safer endovascular approaches such as angioplasty alone. These will need to be tested in future clinical trials. Overall, symptomatic ICAD remains a high risk condition with suboptimal treatment options.

Original languageEnglish (US)
Pages (from-to)335-347
Number of pages13
JournalCurrent Treatment Options in Cardiovascular Medicine
Volume15
Issue number3
DOIs
StatePublished - Jun 1 2013

Keywords

  • Diagnostic imaging
  • Intracranial atherosclerotic disease
  • Management
  • Risk stratification
  • Stroke
  • Stroke mechanism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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