Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis
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:
- aggressive medical management with dual antiplatelet therapy plus intensive control of vascular risk factors, and
- 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
...Diagnosis...
...should utilize diagnostic modalities to diagn...
Treatment
...Tre...
...d recommend aspirin 325 mg/d over warfar...
...should recommend adding clopidogrel 75 m...
...inicians may recommend adding cilost...
...linicians should recommend high-intensity...
...uld recommend a long-term blood pressure t...
...hould recommend at least moderate physical...
...recommend treatment of other modifiable vascular...
...authors could not achieve consensus on a...
...icians should NOT recommend percutane...
...ld NOT recommend PTAS for stroke prevention...
...ians should NOT routinely recommend angiopl...
...hould counsel patients about the risks of PTAS an...
...ns should NOT recommend direct byp...
...ians must NOT routinely recommend indirect s...
...Pred...
...isk Factor-Control During Follow-upHa...
...ble Risk Factors at BaselineHaving tro...
...able 3. Non-Modifiable Risk Factors at Baseli...