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atherosclerotic intracranial arterial stenosis

Also see WASID trial Complications: - intracranial atherosclerotic disease is associated with increased risk of dementia within 5 years (RR=1.9) - also see vascular dementia Management: 1) warfarin with target INR of 2.0 (aspirin may be superior) 2) aspirin 650 mg PO BID - clopidogrel may be alternative 3) balloon-expandable stent with no benefit [3] - more harm than benefit [3] - increased risk of recurrent stroke or TIA (36.2% at 1 year) relative to medical therapy alone (15.1%) [3] - medical management preferable to stenting even with symptomatic intracranial artery stenosis in patients with TIA or stroke [5]

Related

vascular dementia

General

arterial stenosis arteriosclerosis cerebrovascular disease/disorder

References

  1. Prescriber's Letter 12(5): 2005 Intracranial Arterial Stenosis and Stroke Prevention: Aspirin versus Warfarin Detail-Document#: 210506 (subscription needed) http://www.prescribersletter.com
  2. 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 Mar 31;352(13):1305-16. PMID: 15800226
  3. Zaidat OQ et al Effect of a Balloon-Expandable Intracranial Stent vs Medical Therapy on Risk of Stroke in Patients With Symptomatic Intracranial Stenosis.The VISSIT Randomized Clinical Trial. JAMA. 2015;313(12):1240-1248 PMID: 25803346 http://jama.jamanetwork.com/article.aspx?articleid=2208809 - Chimowitz MI, Derdeyn CP Endovascular Therapy for Atherosclerotic Intracranial Arterial Stenosis. Back to the Drawing Board. JAMA. 2015;313(12):1219-1220 PMID: 25803345 http://jama.jamanetwork.com/article.aspx?articleid=2208785
  4. Hurford R, Wolters FJ, Li L et al. Prognosis of asymptomatic intracranial stenosis in patients with transient ischemic attack and minor stroke. JAMA Neurol 2020 May 26 PMID: 32453401 Free PMC article. https://jamanetwork.com/journals/jamaneurology/fullarticle/2766520
  5. Hurford R, Wolters FJ, Li L et al Prevalence, predictors, and prognosis of symptomatic intracranial stenosis in patients with transient ischaemic attack or minor stroke: a population- based cohort study. Lancet Neurol. 2020 May;19(5):413-421. PMID: 32333899 Free article
  6. Zhao D et al. Intracranial atherosclerotic disease and incident dementia: The ARIC study (Atherosclerosis Risk in Communities). Circulation 2024 Sep 10; 150:838 PMID: 39087353 PMCID: PMC11513165 (available on 2025-09-10) https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067003
  7. NINDS Cerebral Arteriosclerosis Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebral-Arteriosclerosis-Information-Page