Complication of Endovascular Treatment of Intracranial Stenosis

Ischemic stroke is the leading cause of disability and the fourth-leading cause of mortality in the United States. Intracranial atherosclerotic disease (ICAD) is one of the major causes of ischemic stroke in the general population. The pathophysiology is not yet fully understood and, therefore, the optimal treatment modality has yet to be defined. The results of the two most recent large-scale randomized trials (VISSIT and SAMMPRIS) favored maximal medical therapy as a first-line treatment. However, the failure rate of medical therapy is about 12% at 1 year and increases to as high as 22% at 2 years. Furthermore, first generation devices were used in SAMMPRIS with a high reported periprocedural stroke rate. All these factors have led to a renewed interest in endovascular approaches to ICAD, specifically with the development of newer techniques and devices. In addition, even though the current data support medical management for this disease, there is a subset of patients who seem to benefit from angioplasty and stenting. Proper selection criteria must be met, however. Because of the complexity of the pathophysiology, the ever-improving endovascular options, and the high failure rate of current treatment paradigms, further studies are required to advance our understanding of ICAD. Only then will we be able to select the optimal treatment for each subset of patients.