What treatments are available for patients with a stroke or TIA attributable to 50-99% stenosis of a major intracranial artery?
For most patients with ICAS, antithrombotic therapy and vascular risk factor control are effective for stroke prevention. However, for those with severe stenosis (70-99%) of a major intracranial artery and actively progressing symptoms or recurrent TIA or stroke after institution of aspirin and clopidogrel therapy, angioplasty and stenting may be recommended. Extracranial-intracranial bypass surgery is not recommended. Angioplasty and stenting should not be performed as an initial treatment for those with moderate stenosis (50-69%) of a major intracranial artery, as it is associated with increased morbidity and mortality compared with medical management.