Treatment of intracranial carotid stenosis

Evidence-based neurology checklist on treatment of intracranial carotid stenosis: Aspirin alone This is indicated for moderate stenosis of <70% It is also required that the ischaemic event occurred >30 days before It is safer and as effective as Warfarin Aspirin and Clopidogrel Aggressive…

Aspirin alone

  • This is indicated for moderate stenosis of <70%
  • It is also required that the ischaemic event occurred >30 days before
  • It is safer and as effective as Warfarin

Aspirin and Clopidogrel

Aggressive treatment of vascular risk factors

Percutaneous transluminal intracranial angioplasty

Extracranial-intracranial (EC-IC) bypass surgery

References

  1. Prabhakaran S, Romano JG. Current diagnosis and management of symptomatic intracranial atherosclerotic disease. Curr Opin Neurol 2012; 25:18-26. 
  2. Holmstedt CA, Turan TN, Chimowitz MI. Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment. Lancet Neurol 2013; 12:1106-1114.
  3. Wang X, Lin WH, Zhao YD, et al; The CLAIR study investigators. The effectiveness of dual antiplatelet treatment in acute ischemic stroke patients with intracranial arterial stenosis: a subgroup analysis of CLAIR study. Int J Stroke Int J Stroke 2013; 8:663-668. 
  4. Markus HS, Droste DW, Kaps M, et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic carotid Stenosis (CARESS) trial. Circulation 2005; 111:2233-2240.
  5. Wong KSL, Chen C, Fu J, et al. Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blinded-endpoint trial. Lancet Neurol 2010; 9:489-497.
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