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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...

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Autores principales: Kim, Jong S., Bang, Oh Young
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Stroke Society 2017
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.
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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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