Don't you think that, just maybe, it might be important to tell us the results of any treatments?
Intracranial atherosclerotic stenosis: risk factors, diagnosis, and treatment
Published:February 07, 2022DOI:https://doi.org/10.1016/S1474-4422(21)00376-8
Summary
Intracranial atherosclerotic stenosis (ICAS) is one of the most frequent causes of
stroke worldwide and confers one of the greatest risks of recurrent stroke compared
with other causes of stroke. Asymptomatic ICAS is increasingly recognised as a risk
factor for silent brain infarctions and dementia, magnifying the global burden of
ICAS. Although ICAS is a lumen-based diagnosis, newer diagnostic imaging techniques,
such as high-resolution MRI, might help to identify high-risk population subgroups
to test interventions that might reduce the risk of stroke recurrence. Secondary stroke
prevention in patients with ICAS currently consists of intensive management of modifiable
risk factors and dual antiplatelet therapy, which is subsequently reduced to aspirin
alone. Despite these therapies, the risk of recurrent stroke in patients presenting
with stroke related to 70–99% ICAS exceeds 20% at 1 year; as such, better therapies
are urgently needed. The optimal duration and combination of dual antiplatelet therapy
in patients with ICAS is uncertain and is being investigated in addition to low-dose
anticoagulation and aspirin. Other ongoing or planned studies will provide high-quality
observational data on the role of transluminal angioplasty and stenting, submaximal
balloon angioplasty alone, direct or indirect arterial bypass, and ischaemic conditioning
for prevention of stroke in patients with ICAS.
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