Surgical Strategy for Atherosclerotic Intracranial Stenosis

Abstract

  There are two mechanisms when the atherosclerotic intracranial stenosis becomes symptomatic. First, the intima of the plaque might rupture and cause distal emboli. Second, severe stenosis might cause hemodynamic ischemia in the distal area. The former needs to be treated by aggressive medical treatment to stabilize the plaque, or we need to wait for the improved technique to place the stent across the lesion without irritating the hot and unstable plaque. For the latter, without irritating the severe stenosis with the unstable plaque, the distal low-flow bypass may be an ideal therapeutic choice. Compared with the abrupt direct expansion of stenosis, low-flow bypass could require the gradual flow augmentation as needed, reducing the possibility of hyperperfusion, which might be challenging if the chronic stenotic lesion is accompanied by impaired distal cerebrovascular reserve.