Intracranial Atherosclerotic Disease

Optimal medical therapy for symptomatic intracranial stenosis includes antiplatelet therapy and aggressive management of atherosclerotic medical conditions such as diabetes, hypertension, hyperlipidemia, and cigarette smoking. Systemic anticoagulation is not indicated. Two ongoing clinical trials are currently comparing angioplasty and stenting to medical management; the first report of one of these trials, SAMMPRIS, indicated that medical treatment may be superior to angioplasty and stenting. Angioplasty and stenting should be used with caution and be reserved for patients who remain actively symptomatic despite medical therapy.