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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
CAROTID ANGIOPLASTY AND OTHER CEREBROVASCULAR INTERVENTIONS
Italian Journal of Vascular and Endovascular Surgery 2012 September;19(3):143-51
Intracranial stenosis: update on trials, diagnostic tools and devices
Kakisis J. D., Moulakakis K., Sfyroeras G., Giannakopoulos T. G., Antonopoulos K., Liapis C. D.
Department of Vascular Surgery, Athens University, Medical School, “Attikon” University Hospital, Athens, Greece
Intracranial stenosis accounts for about 8-10% of strokes in North America and 30-50% of strokes in Asia. Digital subtraction angiography is the gold standard for the diagnosis of intracranial stenosis, whereas minimally invasive techniques, such as magnetic resonance angiography and computed tomographic angiography, and noninvasive diagnostic tools, such as transcranial Doppler, are being increasingly used with high sensitivity and specificity. Aspirin has been proven to be equally effective but safer than warfarin for the conservative treatment of patients with intracranial stenosis. Several types of stents, including balloon expandable and self expanding, bare metal and drug-eluting, specifically designed for the cerebral or the coronary arteries, have been used for the endovascular treatment of intracranial stenosis. The reported technical success ranges between 90-99% and the 30-day stroke or death risk between 4.5-15% with an additional 0-7% long-term risk. Restenosis rates range between 0-38%. Until today, there has been only one randomized controlled trial comparing conservative and endovascular treatment of intracranial stenosis, showing that aggressive medical management was superior to stenting, both because the risk of early stroke after stenting was high and because the risk of stroke with aggressive medical therapy alone was lower than expected.