ARISE II Consensus on the Management of Intracranial Atherosclerotic Disease

Stavropoula I Tjoumakaris¹, Joanna M Roy¹, Sepideh Amin-Hanjani², Fady T Charbel³, Guilherme Dabus⁴, Marc Fisher⁵, Matthew Gounis⁶, Brian L Hoh⁷, David S Liebeskind⁸, Italo Linfante⁹, Edgar A Samaniego¹⁰, Gabor Toth¹¹, Osama O Zaidat¹², Pervinder Bhogal¹³, Adam Arthur¹⁴, Ajay K Wakhloo¹⁵; ARISE II Academic Industry Roundtable

Affiliations

¹ Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (S.I.T., J.M.R.).
² Department of Neurological Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, OH (S.A.-H.).
³ Department of Neurological Surgery, University of Illinois at Chicago (F.T.C.).
⁴ Department of Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac and Vascular Institute-Baptist Hospital, FL (G.D.).
⁵ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.F.).
⁶ Department of Radiology, University of Massachusetts Chan Medical School, Worcester (M.G.).
⁷ Department of Neurosurgery, University of Florida, Gainesville (B.L.H.).
⁸ Department of Neurology, University of California, Los Angeles, LA (D.S.L.).
⁹ Department of Interventional Neuroradiology and Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, FL (I.L.).
¹⁰ Department of Neurology, The University of Iowa Hospitals and Clinics (E.A.S.).
¹¹ Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH (G.T.).
¹² Department of Neuroscience and Stroke Program, Bon Secours Mercy Health St Vincent Hospital, Toledo, OH (O.O.Z.).
¹³ Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, United Kingdom (P.B.).
¹⁴ Department of Neurosurgery, University of Tennessee Health Science Center, Memphis (A.A.).
¹⁵ Department of Radiology, TUFTS University School of Medicine, Boston, MA (A.K.W.).

PMID: 40408521
DOI: 10.1161/STROKEAHA.124.050336

Review

ARISE II Consensus on the Management of Intracranial Atherosclerotic Disease

Stavropoula I Tjoumakaris et al. Stroke. 2025 Jun.

. 2025 Jun;56(6):1636-1641.

doi: 10.1161/STROKEAHA.124.050336. Epub 2025 May 23.

Authors

Affiliations

¹ Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (S.I.T., J.M.R.).
² Department of Neurological Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, OH (S.A.-H.).
³ Department of Neurological Surgery, University of Illinois at Chicago (F.T.C.).
⁴ Department of Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac and Vascular Institute-Baptist Hospital, FL (G.D.).
⁵ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.F.).
⁶ Department of Radiology, University of Massachusetts Chan Medical School, Worcester (M.G.).
⁷ Department of Neurosurgery, University of Florida, Gainesville (B.L.H.).
⁸ Department of Neurology, University of California, Los Angeles, LA (D.S.L.).
⁹ Department of Interventional Neuroradiology and Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, FL (I.L.).
¹⁰ Department of Neurology, The University of Iowa Hospitals and Clinics (E.A.S.).
¹¹ Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH (G.T.).
¹² Department of Neuroscience and Stroke Program, Bon Secours Mercy Health St Vincent Hospital, Toledo, OH (O.O.Z.).
¹³ Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, United Kingdom (P.B.).
¹⁴ Department of Neurosurgery, University of Tennessee Health Science Center, Memphis (A.A.).
¹⁵ Department of Radiology, TUFTS University School of Medicine, Boston, MA (A.K.W.).

PMID: 40408521
DOI: 10.1161/STROKEAHA.124.050336

Abstract

Intracranial atherosclerotic disease (ICAD) is one of the leading causes of ischemic stroke worldwide. Despite advances in its diagnosis and management, there is no clear consensus on best practices to manage ICAD. This report summarizes the ARISE II (Roundtable Discussion With Industry and Stroke Experts) consensus in treating ICAD. The consensus underscored the importance of lifestyle modification and medical management in patients with ICAD. Patients who fail medical management are candidates for endovascular treatment. Open surgery is not recommended in patients who lack demonstrated hemodynamic insufficiency. The consensus also identified gaps in knowledge about the optimal duration of antithrombotics, the effect of the CYP2C19 genotype on medical management, the need for newer devices, and the standardization of antithrombotic protocols before stenting in an acute setting. Optical coherence tomography requires additional clinical data before defining its role in the diagnosis of ICAD.

Keywords: intracranial atherosclerotic disease; ischemic stroke; microsurgery; practice management, medical; stroke.

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Conflict of interest statement

Dr Tjoumakaris reports compensation from Medtronic and Microvention Inc for consultant services. Dr Charbel reports compensation from Transonic Systems Inc for consultant services. Dr Dabus reports compensation from Stryker for consultant services; stock holdings in RIST; compensation from Phenox Inc, Route 92 Medical Inc, Cerenovus, Medtronic, and Penumbra Inc for consultant services; stock holdings in InNeuroCo; and compensation from MicroVention Inc for consultant services. Dr Fisher reports compensation from Moleac for data and safety monitoring services; compensation from Simcere USA, Lumosa, and Revalesio for consultant services; and employment by Beth Israel Deaconess Medical Center. Dr Gounis reports compensation from Q’Apel Medical for consultant services; stock holdings in Imperative Care Inc; stock holdings in InNeuroCo LLC; compensation from Mentice and Stryker Corporation for consultant services; stock holdings in GalaxyTherapeutics; compensation from Spryte Medical for consultant services; stock holdings in Synchron; compensation from Medtronic Neurovascular, Phenox Inc, Jacob’s Institute, Route 92 Medical Inc, Cerenovus, Wallaby Medical, BendIt Technologies, Mivi Neurosciences, Scientia Vascular Inc, and Imperative Care Inc for consultant services. Dr Hoh reports compensation from Janssen Pharmaceuticals for other services; grants from the National Institutes of Health; employment by the College of Medicine, University of Florida; and compensation from AstraZeneca for other services. Dr Liebeskind reports compensation from Medtronic, Rapid Medical Ltd, Stryker, Cerenovus, and Genentech for consultant services. Dr Samaniego reports compensation from Medtronic for consultant services; employment by the University of Iowa; compensation from MicroVention Inc, Johnson and Johnson, and Rapid Medical for consultant services. Dr Toth reports compensation from Medtronic USA Inc for other services; and compensation from Kaneka Pharma America LLC, EBSCO, and Penumbra Inc for consultant services. Dr Bhogal reports stock options in Brainomix; travel support from Perflow; compensation from Phenox Inc and Vesalio for consultant services; stock options in Perfuze; compensation from NeuroVasc Technologies Inc for consultant services; stock holdings in CeroFlo; compensation from Cerenovus, Q’Apel, and Vesalio for consultant services; stock options in Toro; and compensation from Brainomix for consultant services. Dr Arthur reports stock holdings in Scientia; stock holdings in Bendit; stock options in Endovascular Horizons; compensation from Siemens Medical Solutions USA Inc, Perfuze, and Arsenal Bio for consultant services; stock options in Arsenal Bio; compensation from Stryker Corporation for consultant services; stock holdings in Vastrax; compensation from Medtronic USA Inc, Johnson and Johnson International, Scientia, Penumbra Inc, Balt USA, LLC, and MicroVention Inc for consultant services. Dr Wakhloo reports compensation from Stryker, Stryker Corporation, and Philips for consultant services; an ownership stake in Neurofine; grants from Philips; compensation from Cerenovus J&J and Acotec for consultant services; an ownership stake in Deinde Medical; compensation from Stryker Corporation for consultant services; and an ownership stake in Prometheus Therapeutics. The other authors report no conflicts.

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ARISE II Consensus on the Management of Intracranial Atherosclerotic Disease

Affiliations

ARISE II Consensus on the Management of Intracranial Atherosclerotic Disease

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources