Title : Intracranial atherosclerotic disease: Diagnosis, treatment options, and outcome
Abstract:
Intracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke worldwide, particularly in Asian and African countries, and poses one of the greatest risks for recurrent stroke compared to other stroke causes. It refers to the narrowing of intracranial arteries due to plaque formation, leading to reduced blood flow and an increased risk of ischemic events. ICAD is divided into asymptomatic and symptomatic subgroups. Asymptomatic ICAD is increasingly recognized as a significant risk factor for silent brain infarctions and dementia, contributing to the growing global burden of ICAD. Risk factors for both groups are similar and include hypertension, diabetes mellitus, metabolic syndrome, age, Asian and Black race, hyperlipidemia, sedentary lifestyle, and smoking.
Diagnosis requires advanced imaging techniques, including magnetic resonance angiography (MRA), computed tomography angiography (CTA), and digital subtraction angiography (DSA), which provide detailed visualization of vascular abnormalities and plaque characteristics.
Treatment strategies for ICAD are diverse and tailored to the severity of stenosis and the patient's clinical condition. Medical management primarily focuses on tight control of modifiable risk factors, such as blood pressure, cholesterol, and blood sugar levels, combined with dual antiplatelet therapy to prevent thromboembolic events. The duration of dual antiplatelet therapy is generally considered to be 90 days, according to the latest guidelines. In cases of severe stenosis or recurrent symptoms despite optimal medical treatment, interventional procedures like angioplasty and stenting may be considered. However, the effectiveness of these interventions remains debated, as they carry risks of complications, such as vessel dissection or in-stent restenosis. The outcomes of ICAD treatment can vary, with many patients benefiting from a reduced risk of recurrent stroke through appropriate management. However, the prognosis is less favorable in cases of severe disease or when treatment options are limited. Long-term follow-up is essential to monitor for complications and adjust treatment as necessary. Ongoing research is needed to refine treatment strategies and improve patient outcomes in this complex and challenging condition.
