An update on interventional revascularization therapy of intracranial arterial steno-occlusive diseases

ABSTRACT

Intracranial arterial stenosis (ICAS) has been recognized as one of the major causes of ischemic stroke especially in Asian countries including Korea. There have been some arguments on the optimal management strategy over this condition. The purpose of this review is to briefly summarize its clinical significance and the current status of neurointerventional revascularization treatment. The mechanisms of stroke in ICAS are hemodynamic insufficiency, artery-to-artery embolism, athero-thrombosis, or branch artery occlusion. The first-line treatment of symptomatic ICAS is medical treatment. Balloon angioplasty followed by stent placement can be performed to improve perfusion abnormality and elimination of future embolic sources. However, a recent randomized trial on stent vs. medical management failed to show any benefit of angioplasty/stenting. Endovascular therapy is now reserved only for high-risk symptomatic cases refractory to the best medical management. High-resolution magnetic resonance imaging may help provide a better understanding of the disease and patient selection for the optimal treatment modality. Improvement of the device is mandatory to facilitate procedure safety and efficacy. The role of strict medical management which, includes risk factor modification in ICAS, has become critical. Patient outcomes could be improved if we could provide safer and efficacious technology and procedural techniques for intracranial angioplasty and stenting, especially in selected high-risk patients.