Medical Management of Intracranial Atheroclerotic Stenosis

Intracranial atherosclerotic stenosis (ICAS) is a risk factor for ischemic stroke, and the primary aim of management is stroke prevention. The natural history of ICAS is influenced by symptomatic versus asymptomatic status, with symptomatic ICAS having a high recurrent stroke risk. The risk of stroke in symptomatic ICAS is dependent on many factors which will be reviewed in this chapter, including timing after symptoms, degree of stenosis, gender, and possibly other radiographic features (location of stenosis, radiographic progression). Medical management of symptomatic ICAS should include secondary prevention strategies. Based upon the WASID study, aspirin is preferred over Warfarin. Vascular risk factor modification should be promoted in all patients with ICAS to reduce recurrent stroke and vascular events. Despite medical therapy, symptomatic ICAS is associated with a significant recurrent stroke risk.