Symptomatic intracranial atherosclerotic disease: what is the best treatment option?

See related article, pages 1766–1769. Symptomatic intracranial atherosclerotic disease carries a significant risk for future ipsilateral ischemic events regardless of the use of warfarin or aspirin.1 Patients presenting with a lesion that is >70% appear to be most vulnerable with a 1-year risk of 23% for a subsequent ipsilateral event.2 Moreover, poor control of blood pressure and cholesterol appear to be associated with a higher risk of a subsequent stroke. At 1-year follow-up in the WASID study, 58% of patients were still found to have a LDL cholesterol of >100 mg/dL despite 91% of patients being on lipid-lowering therapy, and 50% of patients were found to have a systolic blood pressure >140 mm Hg.3 Recent guidelines suggest that patients at high risk for vascular disease may benefit from LDL cholesterol levels below 70 mg/dL,4 which was achieved in only 12% of patients in the WASID study at 1-year follow-up.3 This has highlighted the importance of vascular neurologists being more aggressive with risk factor modification as stroke victims are at a high risk …

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