cardiovascular-agents and Intracranial-Arteriosclerosis

This review highlights the recent evolution of the imaging, medical management, surgical options and endovascular therapies for symptomatic intracranial atherosclerotic disease (ICAD). Recent imaging developments including optical coherence tomography and other modalities to assess the intracranial arteries for symptomatic ICAD are reviewed, not only to diagnose ICAD but to determine if ICAD plaques have any high-risk features for treatment. Potential future developments in the treatment of ICAD are discussed, including the development of trackable drug-coated balloons for the cerebral circulation to treat primary or restenotic arteries, new iterations of self-expanding intracranial stents with easier delivery systems, and the re-examination of indirect surgical bypass techniques for revascularisation. In addition to these important technological developments, however, is the evolving evidence regarding the best treatment window for these techniques and additional factors in medical management which can improve patient outcomes in this devastating pathology.

Topics: Cardiovascular Agents; Cerebrovascular Circulation; Clinical Decision-Making; Endovascular Procedures; Humans; Intracranial Arteriosclerosis; Neurosurgical Procedures; Plaque, Atherosclerotic; Risk Assessment; Risk Factors; Risk Reduction Behavior; Stents; Treatment Outcome

Revascularization of stenotic cerebral arteries is hypothesized to improve cognition by increasing cerebral perfusion.. We compared cognition impairment among patients treated with percutaneous angioplasty and stenting (PTAS) and aggressive medical management (AMM) versus AMM alone in the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) Trial.. In SAMMPRIS, 451 patients with recent transient ischemic attack or stroke attributed to 70-99% intracranial stenosis were randomized to PTAS plus AMM or AMM alone. Patients who had stroke as the qualifying event with National Institutes of Health Stroke Scale indicating aphasia or neglect were excluded from these analyses. Patients with a cerebrovascular event (ischemic stroke, cerebral infarct with temporary signs or intracranial hemorrhage) during follow-up were excluded from follow-up visit analyses. The Montreal Cognitive Assessment (MoCA) score was used to assess cognition impairment at baseline, 4 months, 12 months and closeout. Cognitive impairment was defined as MoCA <26. Mean MoCA scores and the percentage of patients with cognitive impairment were compared between treatment groups at each time point using t tests and chi-square tests. Differences in MoCA mean at baseline and follow-up time points were compared using mixed model repeated measures ANOVA and Tukey-Kramer tests.. There were no significant differences between the treatment groups for mean MoCA at any time point. Mean MoCA scores improved in both groups. The percentage of patients with cognitive impairment in the AMM versus PTAS groups was not significantly different at any time point.. Revascularization with PTAS showed no improvement in cognitive impairment over AMM alone among patients who did not have recurrent cerebrovascular events during follow-up.

Topics: Angioplasty; Cardiovascular Agents; Chi-Square Distribution; Cognition; Cognition Disorders; Humans; Intracranial Arteriosclerosis; Neuropsychological Tests; Recovery of Function; Risk Factors; Stents; Time Factors; Treatment Outcome

Topics: Angioplasty, Balloon; Cardiovascular Agents; Combined Modality Therapy; Constriction, Pathologic; Humans; Intracranial Arteriosclerosis; Research Design; Risk Assessment; Risk Factors; Risk Reduction Behavior; Secondary Prevention; Stents; Stroke; Treatment Outcome

To assess the short-term prognosis of patients with recent symptomatic intracranial atherosclerotic disease in the posterior circulation and evaluate differences in the outcome of patients receiving medical or endovascular treatment.. The records of 50 consecutive patients with symptomatic intracranial atherosclerotic disease in the posterior circulation were reviewed to record the occurrence of transient ischemic attack, stroke, major bleeding, and/or death during the 12-month period following a neurological event. Twenty-five patients received medical treatment alone, 13 initially received medical treatment and subsequently were treated with angioplasty/stenting due to recurrent events (analyzed in both groups), and 12 patients received endovascular treatment initially. The crossover patients were considered as 1 treated patient in each group; thus, there were 38 subjects (33 men; mean age 68+/-9 years) receiving medical therapy compared with 25 patients (21 men; mean age 63+/-13 years) who underwent endovascular procedures.. During the 12-month period, subjects in the medically-treated group had a higher rate of events (37%, 14/38) than patients who received angioplasty/stenting (12%, 3/25; p = 0.042). Notably, there were 7 (18%) TIAs and 6 (16%) strokes in medically-treated patients versus no TIAs (0%, p = 0.035) and only 2 (8%, p = NS) strokes in the endovascular group, both of which occurred within 48 hours of the procedure. There were no deaths and only a single major bleeding event in each group.. Endovascular treatment of patients with symptomatic intracranial disease of the posterior territory appears to be associated with a substantially better outcome.

Topics: Aged; Angioplasty; Argentina; Cardiovascular Agents; Cerebrovascular Circulation; Chi-Square Distribution; Female; Hemorrhage; Humans; Intracranial Arteriosclerosis; Ischemic Attack, Transient; Male; Middle Aged; Retrospective Studies; Risk Assessment; Risk Factors; Stents; Stroke; Time Factors; Treatment Outcome

Topics: Cardiovascular Agents; Dihydroergotoxine; Drug Therapy; Ergot Alkaloids; Geriatrics; Hypertension; Intracranial Arteriosclerosis; Tuberous Sclerosis