32 Intracranial Atherosclerotic Disease

Kunal Vakharia, Muhammad Waqas, and Elad I. Levy

Abstract

Intracranial atherosclerotic disease (ICAD) is the second leading cause of stroke in the United States and the leading cause of ischemic strokes in Asia. Antiplatelet agents and control of risk factors remain the mainstay of treatment. Dual-antiplatelet therapy has been found superior to single-agent therapy. Endovascular management of ICAD is evolving rapidly. Endovascular treatment of the stenotic area is recommended for patients who are symptomatic with a previous history of two or more ischemic events (strokes or a transient ischemic attack) despite best medical therapy. Underlying ICAD is also a common cause of failed acute revascularization after mechanical thrombectomy for large-vessel occlusion (LVO). Poor revascularization after mechanical thrombectomy for LVO has emerged as another indication for submaximal angioplasty with or without stenting in such cases. External carotid artery-to-middle cerebral artery bypass may benefit a subset of patients with medically refractory disease and few comorbidities.

Key words

intracranial atherosclerotic disease - large-vessel occlusion - SAMMPRIS - submaximal angioplasty - stroke

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