Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis Practice Advisory

 Notice this is the Guideline Process Manual NOT the Protocol Process Manual so just a suggestion NOT a requirement. Words matter.

Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis Practice Advisory

Report of the AAN Guideline(Not protocol) Subcommittee

Tanya N. Turan, Osama O. Zaidat, Gary S. Gronseth, Marc I. Chimowitz, Antonio Culebras, Anthony J. Furlan, View ORCID ProfileLarry B. Goldstein, View ORCID ProfileNestor R. Gonzalez, Julius G. Latorre, Steven R. Messé, View ORCID ProfileThanh N. Nguyen, Rajbeer S. Sangha, Michael J. Schneck, Aneesh B. Singhal, Lawrence R. Wechsler, Alejandro A. Rabinstein, Mary Dolan O'Brien, Heather Silsbee, Jeffrey J. Fletcher

First published March 21, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200030

Full PDF

Citation

Permissions

Make Comment

See Comments

• Article
• Figures & Data
• Info & Disclosures

Abstract

Background and Objectives To review treatments for reducing the risk of recurrent stroke or death in patients with symptomatic intracranial atherosclerotic arterial stenosis (sICAS).

Methods The development of this practice advisory followed the process outlined in the American Academy of Neurology Clinical Practice Guideline Process Manual, 2011 Edition, as amended. The systematic review included studies through November 2020. Recommendations were based on evidence, related evidence, principles of care, and inferences.

Major Recommendations Clinicians should recommend aspirin 325 mg/d for long-term prevention of stroke and death and should recommend adding clopidogrel 75 mg/d to aspirin for up to 90 days to further reduce stroke risk in patients with severe (70%–99%) sICAS who have low risk of hemorrhagic transformation. Clinicians should recommend high-intensity statin therapy to achieve a goal low-density lipoprotein cholesterol level <70 mg/dL, a long-term blood pressure target of <140/90 mm Hg, at least moderate physical activity, and treatment of other modifiable vascular risk factors for patients with sICAS. Clinicians should not recommend percutaneous transluminal angioplasty and stenting for stroke prevention in patients with moderate (50%–69%) sICAS or as the initial treatment for stroke prevention in patients with severe sICAS. Clinicians should not routinely recommend angioplasty alone or indirect bypass for stroke prevention in patients with sICAS outside clinical trials. Clinicians should not recommend direct bypass for stroke prevention in patients with sICAS. Clinicians should counsel patients about the risks of percutaneous transluminal angioplasty and stenting and alternative treatments if one of these procedures is being contemplated.