Standard of practice: endovascular treatment of intracranial atherosclerosis: Table 1

Abstract

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.

Symptom Differences and Pretreatment Asymptomatic Interval Affect Outcomes of Stenting for Intracranial Atherosclerotic Disease

“…[1][2][3] Some lesions prove recalcitrant to first-line medical management, and, in recent decades, endovascular treatments have emerged and evolved as complementary therapies. 4,5 Early series demonstrated technical feasibility and acceptable safety for percutaneous transluminal angioplasty (PTA) and then stent placement of lesions in ICAD. [5][6][7][8][9][10][11][12][13][14][15][16][17] Initially, intracranial procedures were performed with devices designed and approved for coronary interventions, with subsequent release of angioplasty balloons specifically engineered for intracranial use.…”

“…4,5 Early series demonstrated technical feasibility and acceptable safety for percutaneous transluminal angioplasty (PTA) and then stent placement of lesions in ICAD. [5][6][7][8][9][10][11][12][13][14][15][16][17] Initially, intracranial procedures were performed with devices designed and approved for coronary interventions, with subsequent release of angioplasty balloons specifically engineered for intracranial use. 5,12,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] In 2005, the Wingspan stent system with Gateway PTA balloon catheter (Stryker, Kalamazoo, Michigan) became the first stent approved for treatment of ICAD in the United States.…”

“…5,12,[18][19][20][21][22]25,34 Numerous studies reported progressively improved outcomes and low complication rates, but randomized data proving efficacy were lacking. 5,12,18,20,24,25,35,36 In 2011, enrollment in the first randomized, controlled trial to evaluate stent placement versus medical management of ICAD, the Stent placement and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, was halted early due to high complication rates in the stent placement group as compared with the medical management group. 4 The results of SAMMPRIS have elicited strong responses from both proponents and detractors of stent placement, with clinical decisions now changing.…”

“…5,12,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] In 2005, the Wingspan stent system with Gateway PTA balloon catheter (Stryker, Kalamazoo, Michigan) became the first stent approved for treatment of ICAD in the United States. 5,12,[18][19][20][21][22]25,34 Numerous studies reported progressively improved outcomes and low complication rates, but randomized data proving efficacy were lacking. 5,12,18,20,24,25,35,36 In 2011, enrollment in the first randomized, controlled trial to evaluate stent placement versus medical management of ICAD, the Stent placement and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, was halted early due to high complication rates in the stent placement group as compared with the medical management group.…”

“…[5][6][7][8][9][10][11][12][13][14][15][16][17] Initially, intracranial procedures were performed with devices designed and approved for coronary interventions, with subsequent release of angioplasty balloons specifically engineered for intracranial use. 5,12,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] In 2005, the Wingspan stent system with Gateway PTA balloon catheter (Stryker, Kalamazoo, Michigan) became the first stent approved for treatment of ICAD in the United States. 5,12,[18][19][20][21][22]25,34 Numerous studies reported progressively improved outcomes and low complication rates, but randomized data proving efficacy were lacking.…”