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
...gnosis...
...hould utilize diagnostic modalities to diagnose...
Treatment
...reatmen...
...ns should recommend aspirin 325 mg/d over w...
...ould recommend adding clopidogrel 75 mg/d to aspi...
...may recommend adding cilostazol 20...
...nicians should recommend high-intensity statin t...
...uld recommend a long-term blood press...
...inicians should recommend at least moderate...
...st recommend treatment of other modifia...
...ld not achieve consensus on a recommendation fo...
...d NOT recommend percutaneous translumin...
...ns should NOT recommend PTAS for stroke pr...
...d NOT routinely recommend angioplasty alone f...
...should counsel patients about the risks of PTAS...
...uld NOT recommend direct bypass for...
...s must NOT routinely recommend indirect surgi...
...edictors of Recurrent Stroke or Death...
...ctor-Control During Follow-upHaving t...
...2. Modifiable Risk Factors at Base...
...difiable Risk Factors at BaselineHaving trouble vi...