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Intracranial Atherosclerotic Disease

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Introduction to Vascular Neurosurgery

Abstract

Intracranial atherosclerotic disease is the second leading cause of stroke in the United States accounting for about 8–10% of all ischemic strokes. Its impact is even higher in Asian populations where intracranial atherosclerotic disease is responsible for approximately 50% of strokes. The treatment paradigms for this disease have evolved over the past few decades. Extracranial to intracranial bypass, which was one of the initial treatments of atherosclerotic disease, failed to provide any benefit in randomized trials. Maximal medical therapy is continuously improving with newer, more potent drugs, a better understanding of risk factors and their effect on atherosclerosis, and an improved ability to detect resistance to certain medication and provide alternatives. Endovascular therapy, despite initial promise, failed to show significant benefit in this population. However, more nuanced approaches to these patients are starting to emerge with a clear role for interventions, which include submaximal angioplasty, stenting, and indirect bypass. In this chapter, we discuss the epidemiology, natural history, risk factors, diagnosis, and treatment of intracranial atherosclerotic disease.

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Correspondence to Erol Veznedaroglu .

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Rahme, R.J., Veznedaroglu, E. (2022). Intracranial Atherosclerotic Disease. In: Mascitelli, J.R., Binning, M.J. (eds) Introduction to Vascular Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-88196-2_14

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  • DOI: https://doi.org/10.1007/978-3-030-88196-2_14

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