Current diagnosis and management of symptomatic intracranial atherosclerotic disease

Shyam Prabhakaran, Jose G. Romano*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

17 Scopus citations


Purpose of review: Intracranial atherosclerotic disease (IAD) is likely the most common cause of stroke world-wide and is associated with a very high risk of recurrence. It results in cerebral ischemia due to a variety of mechanisms, including artery-to-artery embolism, hemodynamic failure, and occlusion of penetrating arteries. New imaging modalities focused on physiological consequences of IAD have become available and recent treatment trials have been completed. Recent findings: We review the traditional imaging modalities, emphasizing the advantages and limitations of each method, and discuss the novel physiological approaches that interrogate physiological process to indicate specific mechanisms of ischemia. These allow deeper understanding of the pathophysiological processes that underlie IAD-related ischemia. The key findings of recent therapeutic trials are reviewed, including the landmark randomized studies showing advantage of antiplatelet agents and risk factor modification, and a significant risk of complications with endovascular approaches. Summary: Current evidence argues for aggressive medical management and suggests caution with interventional treatments. We propose that mechanistic information will further refine the risk assessment of patients with IAD to offer targeted therapy.

Original languageEnglish (US)
Pages (from-to)18-26
Number of pages9
JournalCurrent Opinion in Neurology
Issue number1
StatePublished - Feb 2012


  • intracranial atherosclerosis
  • intracranial stenting
  • stroke
  • stroke cause
  • stroke therapy

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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