Journal article
Standard of practice: endovascular treatment of intracranial atherosclerosis
Journal of neurointerventional surgery, Vol.4(6), pp.397-406
11/2012
DOI: 10.1136/neurintsurg-2012-010405
PMID: 22705876
Abstract
Background Symptomatic intracranial atherosclerotic disease (ICAD) worldwide represents one of the most prevalent causes of stroke. When severe, studies show that it has a very high risk for recurrent stroke, highlighting the need for effective preventative strategies. The mainstay of treatment has been medical therapy and is of critical importance in all patients with this disease. Endovascular therapy is also a possible therapeutic option but much remains to be defined in terms of best techniques and patient selection. This guideline will serve as recommendations for diagnosis and endovascular treatment of patients with ICAD. Methods A literature review was performed to extract published literature regarding ICAD, published from 2000 to 2011. Evidence was evaluated and classified according to American Heart Association (AHA)/American Stroke Association standard. Recommendations are made based on available evidence assessed by the Standards Committee of the Society of NeuroInterventional Surgery. The assessment was based on guidelines for evidence based medicine proposed by the American Academy of Neurology (AAN), the Stroke Council of the AHA and the University of Oxford, Centre for Evidence Based Medicine (CEBM). Results 59 publications were identified. The SAMMPRIS study is the only prospective, randomized, controlled trial available and is given an AHA level B designation, AAN class II and CEBM level 1b. The Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial arteries (SSYLVIA) trial was a prospective, non-randomized study with the outcome assessment made by a non-operator study neurologist, allowing an AHA level B, AAN class III and CEBM level 2. The remaining studies were uncontrolled or did not have objective outcome measurement, and are thus classified as AHA level C, AAN class IV and CEBM level 4. Conclusion Medical management with combination aspirin and clopidogrel for 3 months and aggressive risk factor modification is the firstline therapy for patients with symptomatic ICAD. Endovascular angioplasty with or without stenting is a possible therapeutic option for selected patients with symptomatic ICAD. Further studies are necessary to define appropriate patient selection and the best therapeutic approach for various subsets of patients.
Details
- Title: Subtitle
- Standard of practice: endovascular treatment of intracranial atherosclerosis
- Creators
- M Shazam Hussain - Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USAJustin F Fraser - Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USATodd Abruzzo - Neurosurgery, Radiology, Pediatrics and Biomedical Engineering, University of Cincinnati, Mayfield Clinic and Cincinnati Children's Hospital, Cincinnati, OhioKristine A Blackham - Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USAKetan R Bulsara - Yale Department of Neurosurgery, Yale University, New Haven, Connecticut, USAColin P Derdeyn - Washington University School of Medicine/Barnes Jewish Hospital, St Louis, Missouri, USAChirag D Gandhi - Neurological Institute of New Jersey, New Jersey Medical School, Newark, New Jersey, USAJoshua A Hirsch - Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USADaniel P Hsu - Division of Interventional Neuroradiology, University Hospitals – Case Medical Center, Cleveland, Ohio, USAMahesh V Jayaraman - Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USAPhilip M Meyers - Department of Radiology and Neurological Surgery, Columbia University, College of Physicians and Surgeons, and Neuroendovascular Service, New York Presbyterian-Columbia, Neurological Institute of New York, New York, USASandra Narayanan - Departments of Neurosurgery and Neurology, Wayne State University School of Medicine, Detroit, Michigan, USACharles J Prestigiacomo - Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USAPeter A Rasmussen - Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.4(6), pp.397-406
- DOI
- 10.1136/neurintsurg-2012-010405
- PMID
- 22705876
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Language
- English
- Date published
- 11/2012
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984013998902771
Metrics
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