Treatment of intracranial carotid stenosis
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Treatment of intracranial carotid stenosis. This is indicated for moderate stenosis of <70%. Fully referenced neurology checklist.
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
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Aggressive treatment of vascular risk factors
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Percutaneous transluminal intracranial angioplasty
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Extracranial-intracranial (EC-IC) bypass surgery
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References
- Prabhakaran S, Romano JG. Current diagnosis and management of symptomatic intracranial atherosclerotic disease. Curr Opin Neurol 2012; 25:18-26.
- Holmstedt CA, Turan TN, Chimowitz MI. Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment. Lancet Neurol 2013; 12:1106-1114.
- 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.
- 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.
- 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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