Antithrombotic Therapy for Carotid and Intracranial Artery Stenosis

Abstract

  Recently, the incidence of atherothrombotic cerebral infarction due to cervical internal carotid artery stenosis and intracranial artery stenosis has been increasing as a consequence of changing dietary habits in Japan to more Western style. Antiplatelet therapy is used for the management of atherothrombotic infarction together with the control of risk factors such as hypertension, dyslipidemia and so on. Aspirin, clopidogrel and cilostazol are antiplatelet drugs that are available in Japan and should be used as the situation demands and on the basis of each drug’s properties. Although dual antiplatelet therapy (DAPT) is administered for recurrent cases that persist despite single antiplatelet therapy, prolonged DAPT should be avoided because it increases the risk of intracranial hemorrhage. Also, in the acute stage of stroke, Argatroban and Heparin are used in addition to DAPT. In the case of progressing stroke in spite of maximum antithrombotic therapy, surgical revascularization should be considered in a timely manner.