Stroke Caused by Atherosclerosis of the Major Intracranial Arteries

Abstract

Our goal in this review is to discuss the pathophysiology, diagnosis and treatment of stroke caused by atherosclerosis of the major intracranial arteries. References for the review were identified by searching PubMed for related studies published from 1955 to June 2016 using search terms “intracranial stenosis” and “intracranial atherosclerosis”. Reference sections of published randomized clinical trials and previously published reviews were searched for additional references. Intracranial atherosclerotic disease (ICAD) is a highly prevalent cause of stroke that is associated with a high risk of recurrent stroke. It is more prevalent among blacks, Hispanics and Asians compared with whites. Diabetes, hypertension, metabolic syndrome, smoking, hyperlipidemia and a sedentary lifestyle are the major modifiable risk factors associated with ICAD. Randomized clinical trials comparing aggressive management (dual antiplatelet treatment for 90 days followed by aspirin monotherapy and intensive management of vascular risk factors) with intracranial stenting plus aggressive medical management have shown medical management alone to be safer and more effective for preventing stroke. As such, aggressive medical management has become the standard of care for symptomatic patients with ICAD. Nevertheless, there are subgroups of patients who are still at high risk of stroke despite being treated with aggressive medical management. Future research should aim to establish clinical, serologic, and imaging biomarkers to identify high-risk patients, and clinical trials evaluating novel therapies should be focused on these patients.

Serum SH3BP5-specific Antibody Level is a Biomarker of Atherosclerosis

“…Consistent with this finding; we did not observe significant correlations between BS and HbA1c levels ( Table 6) or complications of DM and s-bSH3BP5-161-Ab levels (Table 5). However, the antibody levels significantly correlated with HT and habitual smoking (Tables 5 and 6), which are well-known risk factors for atherosclerosis [43]. According to ROC analysis, the Table 5: Correlation analysis of s-bSH3BP5-161-Ab levels with data of subjects in the Sawara Hospital cohort.…”

Type 2 diabetes and older age contribute to elevated plasma microparticle concentrations independent of chronic stroke

“…Chronic stroke is associated with long-term vascular consequences that extend far beyond the cerebrum into the periphery (Alexandrova & Bochev, 2005; Billinger et al , 2012; Banerjee & Chimowitz, 2017) and include reduced endothelial vasoreactivity (Ivey et al , 2010) and capillary rarefaction (Prior et al , 2009), most notably in the paretic limb. These vascular complications could, in part, be attributed to MPs with pro-inflammatory effects as we hypothesized that chronic stroke would have elevated MP concentrations compared with other groups.…”

What Threshold Defines Penumbral Brain Tissue in Patients with Symptomatic Anterior Circulation Intracranial Stenosis: An Exploratory Analysis

“…Large vessel disease (intracranial or extracranial) stroke subtype is associated with early neurological deterioration in acute ischemic stroke reaching up to 30% in the first few days and on average 50% of these are intracranial . Intracranial stenosis (ICAS) can cause ischemic stroke either by distal embolization, branch occlusion, or impaired blood flow .…”

“…Large vessel disease (intracranial or extracranial) stroke subtype is associated with early neurological deterioration in acute ischemic stroke reaching up to 30% in the first few days and on average 50% of these are intracranial . Intracranial stenosis (ICAS) can cause ischemic stroke either by distal embolization, branch occlusion, or impaired blood flow . Impaired distal blood flow detected by noninvasive imaging has been shown to predict stroke risk in patients with symptomatic vertebrobasilar and extracranial carotid disease despite of medical therapy …”