Recent medical and endovascular treatment for symptomatic intracranial artery stenosis

Abstract

Atherosclerotic intracranial artery stenosis is a common etiology for ischemic stroke and TIA in Japan with annual stroke rates that approximate 5% to 10%. There are no conclusive answers about the best medical treatment for intracranial stenosis. Recently, the efficacy of dual antiplatelet therapy has been reported. In the SAMMPRIS study, aggressive medical management was superior to balloon angioplasty/stenting with the use of the Wingspan stent system and the 30-day rate of stroke or death was 14.7% in the endovascular group and 5.8% in the medical-management group. The Wingspan stent system was approved in Japan in 2014. The indications of use for the Wingspan system are as follows, 1)dissection, acute occlusion, and impending occlusion after balloon angioplasty, 2) restenosis after balloon angioplasty without any other additional effective treatment. The endovascular treatment for intracranial artery stenosis with the Wingspan stent system has been reported to have a relatively high incidence of ischemic and hemorrhagic complications. However, endovascular treatment via angioplasty without stenting is a relatively low invasive technique with a relatively low rate of technical complications and its effectiveness has been well demonstrated.