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Surgical Management of Intracranial Atherosclerotic Disease

Surgical Management of Intracranial Atherosclerotic Disease Purpose of the reviewIntracranial atherosclerotic disease is a complex stroke etiology with numerous challenges in its management. We present an update on the latest therapeutic research on this disease and the potential role of surgical interventions.Recent findingsDespite improvements in medical therapy, intracranial atherosclerosis presents one of the highest stroke recurrences even with the best contemporary medical management. Interventions such as direct bypass, angioplasty, and stenting have failed to demonstrate superiority to medical management in well-conducted randomized clinical trials. New avenues of research are focusing on alternative interventions such as submaximal angioplasty and indirect bypass.SummaryPatients with intracranial atherosclerosis should undergo intensive medical management. Angioplasty and stenting should be avoided in this population outside of well-designed clinical trials. Surgical strategies are promising but have not been tested in pivotal studies. There is an urgent need for randomized controlled clinical trials to evaluate surgical interventions like indirect bypass in patients with intracranial atherosclerosis. There is a need for early and intermediate development clinical trials for other interventions such as angioplasty without stenting or new stenting techniques. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Treatment Options in Cardiovascular Medicine Springer Journals

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References (54)

Publisher
Springer Journals
Copyright
Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
ISSN
1092-8464
eISSN
1534-3189
DOI
10.1007/s11936-022-00974-1
Publisher site
See Article on Publisher Site

Abstract

Purpose of the reviewIntracranial atherosclerotic disease is a complex stroke etiology with numerous challenges in its management. We present an update on the latest therapeutic research on this disease and the potential role of surgical interventions.Recent findingsDespite improvements in medical therapy, intracranial atherosclerosis presents one of the highest stroke recurrences even with the best contemporary medical management. Interventions such as direct bypass, angioplasty, and stenting have failed to demonstrate superiority to medical management in well-conducted randomized clinical trials. New avenues of research are focusing on alternative interventions such as submaximal angioplasty and indirect bypass.SummaryPatients with intracranial atherosclerosis should undergo intensive medical management. Angioplasty and stenting should be avoided in this population outside of well-designed clinical trials. Surgical strategies are promising but have not been tested in pivotal studies. There is an urgent need for randomized controlled clinical trials to evaluate surgical interventions like indirect bypass in patients with intracranial atherosclerosis. There is a need for early and intermediate development clinical trials for other interventions such as angioplasty without stenting or new stenting techniques.

Journal

Current Treatment Options in Cardiovascular MedicineSpringer Journals

Published: Jan 1, 2023

Keywords: Intracranial atherosclerosis; EDAS; Stroke; Medical management; Angioplasty; Stenting

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