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Review
Update in the treatment of intracranial atherosclerotic disease
  1. Zachary R Barnard,
  2. Michael J Alexander
  1. Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to Dr Michael J Alexander; michael.alexander{at}cshs.org

Abstract

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.

  • stent
  • stenosis
  • atherosclerotic
  • stroke
  • angioplasty
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2019-000279

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    Footnotes

    • Contributors I am the sole author.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MJA is a consultant for Stryker Neurovascular, manufacturer of the Wingspan Stent, which is discussed in the manuscript.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.