Abstract
Intracranial atherosclerosis is the most important cause of stroke worldwide. A thorough knowledge of this disease is necessary to establish the best treatment strategy for each individual patient.
This chapter briefly outlines epidemiological data and the natural history of intracranial atherosclerotic disease. Methods to establish the diagnosis are highlighted, and their advantages and disadvantages are discussed.
The main focus lies on medical and endovascular treatment of patients with symptomatic intracranial atherosclerotic stenosis. Since endovascular treatment is a potentially harmful procedure and incorrect management might increase the risk, patient selection for endovascular treatment, procedural management, and follow-up are comprehensively discussed.
Abbreviations
- Balloon:
-
An inflatable balloon, which is mounted on a microcatheter. It is used to dilate a stenosis by temporary inflation.
- Balloon-mounted stent, balloon-expandable stent:
-
A stent device mounted on an uninflated balloon. Stent expansion and delivery are performed by inflation of the balloon.
- Cerebral ischemia:
-
Impaired brain perfusion.
- Cerebral ischemic deficit:
-
Neurological symptoms caused by impaired brain perfusion. Cerebral ischemia may present as transitory ischemic attack (TIA) or stroke.
- Guide catheter:
-
A stiff, large lumen catheter introduced through a sheath positioned in the extracranial cerebral vessels allowing for access to the intracranial vasculature.
- High-grade intracranial stenosis:
-
Refers to an intracranial stenosis with a luminal narrowing ≥70 %.
- Intermediate catheter:
-
Flexible large lumen guide catheter, which can be introduced in the guide catheter. Flexibility of the device allows for positioning in intracranial vessels reducing the distance between the guide catheter and the target lesion.
- Intracranial stenosis:
-
In the context of this chapter, the term refers to an atherosclerotic lesion with a luminal narrowing ≥50 % excluding stenoses caused by dissection or inflammation.
- Microcatheter:
-
A very small and flexible catheter designed to access and navigate intracranial vessels.
- Microwire:
-
A small wire used to guide the microcatheter in the desired location; typical microwires in this context have an outer diameter of 0.014 in. Navigation is possible by applying torque at the proximal end of the wire.
- Self-expanding stent:
-
A stent device manufactured from Nitinol. Due to the shape memory of Nitinol, the stent expands without additional maneuvers once released from the microcatheter or sheath keeping it unexpanded.
- Sheath:
-
A device introduced percutaneously to allow for permanent arterial access during the procedure.
- Stent:
-
Porous metal tube used as an implant to restore the vessel lumen.
- Stroke, ischemic:
-
A focal neurological deficit caused by impaired brain perfusion with symptoms lasting >24 h.
- TIA:
-
A focal neurological deficit caused by impaired brain perfusion with symptoms lasting <24 h.
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Kurre, W., Bäzner, H., Henkes, H. (2014). Treatment of Intracranial Atherosclerotic Stenoses. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37393-0_99-1
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DOI: https://doi.org/10.1007/978-3-642-37393-0_99-1
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