2019 Volume 28 Issue 12 Pages 783-788
Purpose : Clinical trials did not show the efficacy of endovascular therapy or open surgery for symptomatic intracranial artery stenosis (ICAS). However, the number of the patients resistant or contraindicated for medical therapy is not small, and there is no consensus how to treat such patients. In this report, clinical evidences regarding ICAS treatment were reviewed and treatment selection was discussed.
Background : ICAS accounts for 30% of total cerebral infarction approximately. The recurrence rate of stroke in patients having severe stenosis (>70%) was reported to be around 23% during aspirin treatment and around 12% during aggressive medical therapy including antiplatelets, blood pressure control, lipid lowering, and life style modification such as smoking cessation.
Treatments and clinical evidences : 1) Medical therapy : Randomized controlled trial (RCT) showed that aspirin was superior to warfarin. 2) Two RCTs failed to show the efficacy of endovascular therapy for symptomatic ICAS. Therefore, aggressive medical treatment is regarded as the first option. On the other hand, a new RCT in China is ongoing based on the previous studies. 3) Bypass surgery : There is no RCT aiming to show the efficacy of bypass surgery for ICAS. However, bypass is sometimes performed for the patients who are resistant or contraindicated for other therapies.
Conclusions : The standard treatment is medical therapy according to the clinical trials, however the efficacy of endovascular or other therapies for the medically-refractory patients will be tested in clinical trials.
