Document Detail

Current diagnosis and management of symptomatic intracranial atherosclerotic disease.
MedLine Citation:
PMID:  22143202     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: Intracranial atherosclerotic disease (IAD) is likely the most common cause of stroke world-wide and is associated with a very high risk of recurrence. It results in cerebral ischemia due to a variety of mechanisms, including artery-to-artery embolism, hemodynamic failure, and occlusion of penetrating arteries. New imaging modalities focused on physiological consequences of IAD have become available and recent treatment trials have been completed.
RECENT FINDINGS: We review the traditional imaging modalities, emphasizing the advantages and limitations of each method, and discuss the novel physiological approaches that interrogate physiological process to indicate specific mechanisms of ischemia. These allow deeper understanding of the pathophysiological processes that underlie IAD-related ischemia. The key findings of recent therapeutic trials are reviewed, including the landmark randomized studies showing advantage of antiplatelet agents and risk factor modification, and a significant risk of complications with endovascular approaches.
SUMMARY: Current evidence argues for aggressive medical management and suggests caution with interventional treatments. We propose that mechanistic information will further refine the risk assessment of patients with IAD to offer targeted therapy.
Shyam Prabhakaran; Jose G Romano
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Current opinion in neurology     Volume:  25     ISSN:  1473-6551     ISO Abbreviation:  Curr. Opin. Neurol.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-06     Completed Date:  2012-04-23     Revised Date:  2014-09-21    
Medline Journal Info:
Nlm Unique ID:  9319162     Medline TA:  Curr Opin Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  18-26     Citation Subset:  IM    
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MeSH Terms
Brain Ischemia / etiology
Cerebrovascular Circulation
Constriction, Pathologic / complications,  pathology
Disease Management
Intracranial Arteriosclerosis / complications,  diagnosis*,  physiopathology,  therapy*
Neuroimaging / methods
Risk Factors
Stroke / etiology
Thrombolytic Therapy
Grant Support
1R01NS069938-01/NS/NINDS NIH HHS; R01 NS069938/NS/NINDS NIH HHS; R01 NS069938-01/NS/NINDS NIH HHS; R01 NS069938-02/NS/NINDS NIH HHS; U01 NS058728-01A1/NS/NINDS NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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