Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis

Publication Date: March 17, 2022

Key Points

Key Points

  • Over the last 2 decades, evidence has accumulated informing the treatment of symptomatic intracranial atherosclerotic arterial stenosis (s-ICAS) with 2 general approaches emerging:
    1. aggressive medical management with dual antiplatelet therapy plus intensive control of vascular risk factors, and
    2. medical therapy plus endovascular procedures.
  • Given the high risk of recurrent stroke reported in many studies, clinical trials also focused on identifying and quantifying modifiable and non-modifiable risk factors that may place patients at a particularly high risk of recurrent stroke.
  • Knowledge of predictors of recurrent stroke is crucial for risk stratification, effect modification, and identifying therapeutic targets in future clinical trials.

Diagnosis

...gnosis

...icians should utilize diagnostic mo...


Treatment

...atment...

...d recommend aspirin 325 mg/d over warfarin...

...nicians should recommend adding clopidogrel 75...

...ians may recommend adding cilostazol 200 mg/d to...

...s should recommend high-intensity statin therapy...

...icians should recommend a long-term blood pressure...

...cians should recommend at least mo...

...s must recommend treatment of other modi...

...uld not achieve consensus on a recommendation for...

...cians should NOT recommend percutaneous translum...

...should NOT recommend PTAS for stroke pr...

...d NOT routinely recommend angioplas...

...uld counsel patients about the risks o...

...hould NOT recommend direct bypass for st...

...must NOT routinely recommend indire...


...dictors of Recurrent Stroke or Deat...

...Risk Factor-Control During Follow-...

...odifiable Risk Factors at BaselineHaving...

...-Modifiable Risk Factors at BaselineHaving...