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Medical Treatment of Intracranial Atherosclerosis: An Update
For patients with symptomatic intracranial atherosclerosis (ICAS), antithrombotic agents are the mainstay of therapy. Anticoagulation (warfarin) is not widely used since it is not more effective than aspirin and carries a high risk of bleeding. New oral anticoagulants are showing promise, but their...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Stroke Society
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647642/ https://www.ncbi.nlm.nih.gov/pubmed/29037012 http://dx.doi.org/10.5853/jos.2017.01830 |
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author | Kim, Jong S. Bang, Oh Young |
author_facet | Kim, Jong S. Bang, Oh Young |
author_sort | Kim, Jong S. |
collection | PubMed |
description | For patients with symptomatic intracranial atherosclerosis (ICAS), antithrombotic agents are the mainstay of therapy. Anticoagulation (warfarin) is not widely used since it is not more effective than aspirin and carries a high risk of bleeding. New oral anticoagulants are showing promise, but their use has not been investigated in appropriate clinical trials. Since the recurrent stroke risk is high with aspirin monotherapy, dual antiplatelets are considered in the early stage of symptomatic ICAS. Based on the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) and Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) results, aspirin plus clopidogrel has been recommended. However, this combination was not superior to aspirin monotherapy in patients with ICAS in the CHANCE substudy. Progression of ICAS is common, and it is associated with recurrent strokes. In the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS) study, aspirin plus cilostazol was more effective than aspirin monotherapy in preventing progression. The TOSS II trial showed that the overall change in stenosis was better with aspirin plus cilostazol than with aspirin plus clopidogrel. Aside from antithrombotic therapy, risk factor management is critical for secondary prevention, and high blood pressure is clearly linked to recurrent stroke. However, blood pressure may have to be cautiously managed in the early stage of stroke. Considering that ICAS is the major cause of stroke worldwide, further investigations are needed to establish optimal management strategies for patients with ICAS. |
format | Online Article Text |
id | pubmed-5647642 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Korean Stroke Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-56476422017-10-23 Medical Treatment of Intracranial Atherosclerosis: An Update Kim, Jong S. Bang, Oh Young J Stroke Special Review For patients with symptomatic intracranial atherosclerosis (ICAS), antithrombotic agents are the mainstay of therapy. Anticoagulation (warfarin) is not widely used since it is not more effective than aspirin and carries a high risk of bleeding. New oral anticoagulants are showing promise, but their use has not been investigated in appropriate clinical trials. Since the recurrent stroke risk is high with aspirin monotherapy, dual antiplatelets are considered in the early stage of symptomatic ICAS. Based on the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) and Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) results, aspirin plus clopidogrel has been recommended. However, this combination was not superior to aspirin monotherapy in patients with ICAS in the CHANCE substudy. Progression of ICAS is common, and it is associated with recurrent strokes. In the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS) study, aspirin plus cilostazol was more effective than aspirin monotherapy in preventing progression. The TOSS II trial showed that the overall change in stenosis was better with aspirin plus cilostazol than with aspirin plus clopidogrel. Aside from antithrombotic therapy, risk factor management is critical for secondary prevention, and high blood pressure is clearly linked to recurrent stroke. However, blood pressure may have to be cautiously managed in the early stage of stroke. Considering that ICAS is the major cause of stroke worldwide, further investigations are needed to establish optimal management strategies for patients with ICAS. Korean Stroke Society 2017-09 2017-09-29 /pmc/articles/PMC5647642/ /pubmed/29037012 http://dx.doi.org/10.5853/jos.2017.01830 Text en Copyright © 2017 Korean Stroke Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Special Review Kim, Jong S. Bang, Oh Young Medical Treatment of Intracranial Atherosclerosis: An Update |
title | Medical Treatment of Intracranial Atherosclerosis: An Update |
title_full | Medical Treatment of Intracranial Atherosclerosis: An Update |
title_fullStr | Medical Treatment of Intracranial Atherosclerosis: An Update |
title_full_unstemmed | Medical Treatment of Intracranial Atherosclerosis: An Update |
title_short | Medical Treatment of Intracranial Atherosclerosis: An Update |
title_sort | medical treatment of intracranial atherosclerosis: an update |
topic | Special Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647642/ https://www.ncbi.nlm.nih.gov/pubmed/29037012 http://dx.doi.org/10.5853/jos.2017.01830 |
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