Current Advances in Endovascular Treatment of Intracranial Atherosclerotic Disease and Future Prospective |
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| Authors: | Mostafa Jafari Thanh N. Nguyen Santiago Ortega-Gutierrez Muhammad Shazam Hussain Ameer E. Hassan Asad Ikram Javed Khader Eliyas Gustavo J. Rodriguez Afshin A. Divani |
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| Affiliation: | 2. Department of Neurology, Radiology, Boston University School of Medicine, Boston, MA, United States;3. Departments of Neurology, Neurosurgery and Radiology, University of Iowa, IA, United States;4. Cerebrovascular Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States;5. Departments of Neurology and Radiology, University of Texas Health Science Center - San Antonio, TX, United States;2. Department of Neuroradiology, RWTH Aachen University, D-52074 Aachen, Germany;3. JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, D-52074 Aachen, Germany;2. Clearsense, Jacksonville, FL, USA;3. Northwestern University, Chicago, IL, USA;2. Department of Neurology, Shonan Keiiku Hospital, Japan;2. Department of Cardiology, Kocaeli Government Hospital, Gunes Street, 41300 Kocaeli, Turkey;2. Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China;3. Department of Neurology, Minda Hospital of Hubei Minzu University, Enshi, Hubei, China;4. Department of Neurology, General Hospital of the Yangtze River Shipping, Wuhan, Hubei, China;5. Department of Neurology, Hanyang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China |
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| Abstract: | ![]()
Objectives/BackgroundMedical therapy is the first line of treatment for intracranial atherosclerotic disease (ICAD). Percutaneous transluminal angioplasty and stenting (PTAS) are mainly considered for those patients with severe stenosis and recurrent events despite aggressive medical therapy. In this review, we discuss the application of PTAS as a treatment option for ICAD and its future prospect.Materials and MethodsWe did the literature review of the key articles and guidelines to elaborate on the role of PTAS in the management of ICAD based on the current data and expert opinion. We searched PubMed, Google Scholar, and Scopus up to August 2020, and included articles published only in the English language.ResultsSince the publication of the results from SAMMPRIS and VISSIT trials, stenting is no longer recommended for secondary stroke prevention in patients with symptomatic ICAD. However, recent clinical studies on intracranial stenting for a subgroup of ICAD patients have shown promising results, likely due to better patient selection and continued advancement of endovascular techniques.ConclusionThere exists a lack of consensus regarding the best endovascular treatment approach (e.g., angioplasty alone or balloon mounted stent vs. self-expanding stent with or without prior angioplasty) or management of in-stent restenosis. Another area of clinical controversy relates to the ideal use and duration of antiplatelet therapy. |
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