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Review
. 2017 Feb 3;120(3):502-513.
doi: 10.1161/CIRCRESAHA.116.308441.

Stroke Caused by Atherosclerosis of the Major Intracranial Arteries

Chirantan Banerjee  1 , Marc I Chimowitz  2
Affiliations
Review

Stroke Caused by Atherosclerosis of the Major Intracranial Arteries

Chirantan Banerjee et al. Circ Res. .

Abstract

Our goal in this review is to discuss the pathophysiology, diagnosis, and treatment of stroke caused by atherosclerosis of the major intracranial arteries. References for the review were identified by searching PubMed for related studies published from 1955 to June 2016 using search terms intracranial stenosis and intracranial atherosclerosis. Reference sections of published randomized clinical trials and previously published reviews were searched for additional references. Intracranial atherosclerotic disease is a highly prevalent cause of stroke that is associated with a high risk of recurrent stroke. It is more prevalent among blacks, Hispanics, and Asians compared with whites. Diabetes mellitus, hypertension, metabolic syndrome, smoking, hyperlipidemia, and a sedentary lifestyle are the major modifiable risk factors associated with intracranial atherosclerotic disease. Randomized clinical trials comparing aggressive management (dual antiplatelet treatment for 90 days followed by aspirin monotherapy and intensive management of vascular risk factors) with intracranial stenting plus aggressive medical management have shown medical management alone to be safer and more effective for preventing stroke. As such, aggressive medical management has become the standard of care for symptomatic patients with intracranial atherosclerotic disease. Nevertheless, there are subgroups of patients who are still at high risk of stroke despite being treated with aggressive medical management. Future research should aim to establish clinical, serological, and imaging biomarkers to identify high-risk patients, and clinical trials evaluating novel therapies should be focused on these patients.

Keywords: arteries; aspirin; diabetes mellitus; hypertension; risk factors; stroke.

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Figures

Figure 1
Figure 1
Histological cross-section of intracranial atherosclerosis in basilar artery. Image courtesy Dr. Tanya Turan. Red arrow – fibrous tissue, Blue arrow – vessel wall, Green arrow – lipid
Figure 1
Figure 1
Histological cross-section of intracranial atherosclerosis in basilar artery. Image courtesy Dr. Tanya Turan. Red arrow – fibrous tissue, Blue arrow – vessel wall, Green arrow – lipid
Figure 1
Figure 1
Histological cross-section of intracranial atherosclerosis in basilar artery. Image courtesy Dr. Tanya Turan. Red arrow – fibrous tissue, Blue arrow – vessel wall, Green arrow – lipid
See this image and copyright information in PMC

References

    1. Gorelick PB, Wong KS, Bae HJ, Pandey DK. Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier. Stroke. 2008;39:2396–99. - PubMed
    1. Mathur KS, Kashyap SK, Kumar V. Correlation of the extent and severity of atherosclerosis in the coronary and cerebral arteries. Circulation. 1963;27:929–34. - PubMed
    1. Manzano JJ, De Silva DA, Pascual JL, Chang HM, Wong MC, Chen CP. Associations of ankle-brachial index (ABI) with cerebral arterial disease and vascular events following ischemic stroke. Atherosclerosis. 2012;223:219–22. - PubMed
    1. Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, Levine SR, Chaturvedi S, Kasner SE, Benesch CG, Sila CA, Jovin TG, Romano JG Warfarin-Aspirin Symptomatic Intracranial Disease Trial Investigators. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005;352:1305–16. - PubMed
    1. Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, Janis LS, Lutsep HL, Barnwell SL, Waters MF, Hoh BL, Hourihane JM, Levy EI, Alexandrov AV, Harrigan MR, Chiu D, Klucznik RP, Clark JM, McDougall CG, Johnson MD, Pride GL, Jr, Torbey MT, Zaidat OO, Rumboldt Z, Cloft HJ SAMMPRIS Trial Investigators. Stenting versus aggressive medical therapy for intracranial arterial stenosis. New Engl J Med. 2011;365:993–1003. - PMC - PubMed

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