Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment

Intracranial stenosis before and after angioplasty

Vascular surgeons are treating the extracranial carotid artery stenosis, neurosurgeons and interventionists are treating the intracranial stenotic lesions to reduce the cerebral ischemia which can lead to stroke. In india, intra cranial lesions are more common than the extra cranial artery lesions. So, the number of endarterectomies performed are less in India and few centers are providing these services. The recent developments in proving best medical therapies certainly reduced the risk of stoke in hypertensive patients, Diabetic people.
Intracranial atherosclerosis is one of the most common causes of stroke worldwide and is associated with a high risk of recurrent stroke. New therapeutic approaches to treat this high-risk disease include dual antiplatelet treatment, intensive management of risk factors, and endovascular therapy. Early data from randomised trials indicate that aggressive medical therapy is better than stenting for prevention of recurrent stroke in high-risk patients with atherosclerotic stenosis of a major intracranial artery. Nevertheless, there are subgroups of patients who remain at high risk of stroke despite aggressive medical therapy. Further research is needed to identify these high-risk subgroups and to develop more effective treatments. Non-invasive vascular imaging methods that could be used to identify high-risk patients include fractional flow on magnetic resonance angiography (MRA), quantitative MRA, and high-resolution MRI of the atherosclerotic plaque. Alternative therapies to consider for future clinical trials include angioplasty alone, indirect surgical bypass procedures, ischaemic preconditioning, and new anticoagulants (direct thrombin or Xa inhibitors).
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(13)70195-9/abstract