Intracranial atherosclerosis update for neurointerventionalists

被引:11
作者
Alexander, Michael J. [1 ]
Yu, Wengui [2 ]
机构
[1] Cedars Sinai Med Ctr, Neurosurg, Los Angeles, CA 90048 USA
[2] Univ Calif Irvine, Neurol, Irvine, CA USA
关键词
Atherosclerosis; Stent; Stenosis; Stroke; Intervention; MEDICAL THERAPY; ISCHEMIC-STROKE; STENOSIS; RISK; DISEASE; STENT;
D O I
10.1136/jnis-2022-019628
中图分类号
R445 [影像诊断学];
学科分类号
100207 ;
摘要
The management of intracranial atherosclerotic disease (ICAD) has been evolving with advanced imaging, refinements of best medical treatment, and the development of endovascular options. There has been a significant increase in the use of endovascular therapy for symptomatic ICAD in the USA over the past 6 years. The rationale for this review is to update neurointerventionalists in these areas so that evidence-based decisions can be considered when counseling potential patients regarding their risks, benefits, and potential complications. The landmark SAMMPRIS trial demonstrated superiority of aggressive medical management (AMM) over intracranial stenting as an initial treatment. However, the risk of disabling or fatal stroke remains high in patients presenting with stroke treated with AMM. Recent studies showed a significantly lower rate of periprocedural complications from intracranial stenting. Patients who have failed medical treatment may therefore benefit from intracranial stenting, particularly in those with hemodynamic compromise and large vessel embolic stroke. Drug coated angioplasty balloons and drug eluting stents may potentially reduce the risk of in-stent re-stenosis. Large vessel occlusion (LVO) due to underlying ICAD is seen in a subset of thrombectomy-eligible patients. The use of stenting as a rescue therapy in LVO thrombectomy has also shown promising early results.
引用
收藏
页码:522 / 528
页数:7
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