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Stroke Research and Treatment
Volume 2011 (2011), Article ID 282845, 13 pages
http://dx.doi.org/10.4061/2011/282845
Review Article

Intracranial Atherosclerotic Disease

1Fellow International Cerebrovascular Translational Clinical Research Training Program, Stroke Service, Aga Khan University Hospital, Karachi 74800, Pakistan
2Research Officers, Medical College, Aga Khan University Hospital, Karachi 74800, Pakistan
3Director Stroke Service and Vascular Fellowship Program, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan

Received 9 December 2010; Revised 13 April 2011; Accepted 2 May 2011

Academic Editor: Scott E. Kasner

Copyright © 2011 Maria Khan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Intracranial atherosclerotic disease (ICAD) is the most common proximate mechanism of ischemic stroke worldwide. Approximately half of those affected are Asians. For diagnosis of ICAD, intra-arterial angiography is the gold standard to identify extent of stenosis. However, noninvasive techniques including transcranial ultrasound and MRA are now emerging as reliable modalities to exclude moderate to severe (50%–99%) stenosis. Little is known about measures for primary prevention of the disease. In terms of secondary prevention of stroke due to intracranial atherosclerotic stenosis, aspirin continues to be the preferred antiplatelet agent although clopidogrel along with aspirin has shown promise in the acute phase. Among Asians, cilostazol has shown a favorable effect on symptomatic stenosis and is of benefit in terms of fewer bleeds. Moreover, aggressive risk factor management alone and in combination with dual antiplatelets been shown to be most effective in this group of patients. Interventional trials on intracranial atherosclerotic stenosis have so far only been carried out among Caucasians and have not yielded consistent results. Since the Asian population is known to be preferentially effected, focused trials need to be performed to establish treatment modalities that are most effective in this population.