Endovascular ICA Angioplasty and Stenting Using A Protective Device

The prospective randomized study SAMMPRIS (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) showed that aggressive medical management was superior to stenting, both because the risk of early stroke after stenting was high and the risk of stroke with aggressive medical therapy alone was lower than expected.

Nevertheless, intracranial angioplasty, with or without stent placement, may still be considered for a select group of patients with high-grade stenosis, recurrent ischemia, and medication failure.

ANTERIOR CIRCULATION DISSECTION

The best treatment for stroke prevention in patients with extracranial or intracranial artery dissections in the anterior circulation remains unclear. The 2011 AHA/ASA guidelines recommend the use of antithrombotic treatment for 3 to 6 months as a reasonable option but acknowledge that the relative efficacy of antiplatelet therapy compared with anticoagulation is unknown for these patients.

Even though most cases of carotid artery dissection have a good prognosis with conservative management, a small proportion of patients can develop fluctuating or progressive neurologic deficits secondary to hemodynamic insufficiency and may require more aggressive treatment with stent placement.

Although the number of reported patients with intracranial dissections treated with anticoagulation or antiplatelet treatment is too small for any type of conclusion, both treatments seem to be relatively safe in patients with intracranial dissections without subarachnoid hemorrhage.

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