Treatment
has accumulated informing the
intracranial atherosclerotic arterial
approaches emerging:
dual antiplatelet therapy plus intensive
procedures.
stroke reported in many studies,
identifying and quantifying modifiable
that may place patients at a
stroke.
recurrent stroke is crucial for risk
and identifying therapeutic targets
diagnostic modalities to diagnose s-ICAS
intracranial vasculopathies if the results
management or provide important
aspirin 325 mg/d over warfarin for
death in patients with s-ICAS
adding clopidogrel 75 mg/d to aspirin
stroke risk in patients with severe
risk of hemorrhagic transformation
cilostazol 200 mg/d to aspirin for
stroke risk in patients with s-ICAS and
complications as an alternative to clopidogrel
➤ Clinicians should recommend high-intensity statin therapy to achieve
a goal low-density lipoprotein (LDL) <70 mg/dL in patients with
s-ICAS to reduce the risk of recurrent stroke and vascular events
(Level B).
➤ Clinicians should recommend a long-term blood pressure target of
<140/90 mm Hg in clinically stable patients with s-ICAS to reduce
the risk of recurrent stroke and vascular events (Level B).
➤ Clinicians should recommend at least moderate physical activity in
patients with s-ICAS who are safely capable of exercise to reduce
the risk of recurrent stroke and vascular events (Level B).
➤ Clinicians must recommend treatment of other modifiable vascular
risk factors in patients with s-ICAS to reduce the risk of recurrent
stroke and vascular events (Level A).
➤ The authors could not achieve consensus on a recommendation for
bilateral arm ischemic preconditioning (BAIPC) in patients with
s-ICAS.
➤ Clinicians should NOT recommend percutaneous transluminal
angioplasty and stenting (PTAS) as the initial treatment for stroke
prevention in patients with severe (70%–99%) s-ICAS (Level B).
➤ Clinicians should NOT recommend PTAS for stroke prevention in
patients with moderate (50%–69%) s-ICAS (Level B).
➤ Clinicians should NOT routinely recommend angioplasty alone for
stroke prevention in patients with s-ICAS outside clinical trials
(Level B).
➤ Clinicians should counsel patients about the risks of PTAS
and alternative treatments if one of these procedures is being
contemplated (Level B).
➤ Clinicians should NOT recommend direct bypass for stroke
prevention in patients with s-ICAS (Level B).
➤ Clinicians must NOT routinely recommend indirect surgical
revascularization for stroke prevention in patients with s-ICAS
outside clinical trials (Level A).
