This is the current release of the guideline.

Intracranial cerebral atherosclerosis

To provide a position statement for intracranial angioplasty and stenting for cerebral atherosclerosis

Patients with intracranial stenoses who have failed medical therapy

An in-depth literature search is performed using electronic medical literature databases. The Medline database was searched from 1980 to 2009.

Not stated

Not applicable

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Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Not stated

Current Position Statement of the American Society of Interventional and Therapeutic Neuroradiology (ASITN), Society of Interventional Radiology (SIR), and American Society of Neuroradiology (ASNR)

1. For symptomatic patients with a >50% intracranial stenosis who have failed medical therapy, balloon angioplasty with or without stenting should be considered.
2. Patients who have an asymptomatic intracranial arterial stenosis should first be counseled regarding optimizing medical therapy. There is insufficient evidence to make definitive recommendations regarding endovascular therapy in asymptomatic patients with severe intracranial atherosclerosis. They should be counseled regarding the nature and extent of their disease, monitored for new neurological symptoms, and have periodic noninvasive imaging at regular intervals of 6 to 12 months (magnetic resonance angiography or computed tomographic angiography) initially, and then by cerebral angiography if warranted. At a minimum, optimal prophylactic medical therapy should be instituted, which might include antiplatelet and/or statin therapy.
3. Continued evaluation and improvements in both pharmacological and catheter-based therapies are needed to reduce the stroke burden from intracranial atherosclerosis.

Conclusion

The ASITN, SIR, and ASNR concur that sufficient evidence now exists to recommend that intracranial angioplasty with or without stenting should be offered to symptomatic patients with intracranial stenoses who have failed medical therapy. Endovascular interventions are intensive services provided to patients who are at very high risk for stroke and typically have multiple comorbidities. Similar to revascularization for extracranial carotid artery stenosis, patient benefit from revascularization for symptomatic intracranial arterial stenosis is critically dependent on a low periprocedural stroke and death rate and should thus be performed by experienced neurointerventionists. The guideline developers recommend reimbursement by third party insurers so that these patients may have access to such interventions. Continued attempts to improve medical therapy as well as improve the benefits of endovascular therapy are warranted.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

Prevention of stroke

Complications of intracranial angioplasty include angiographic vessel dissection, vessel thrombosis requiring fibrinolysis, asymptomatic restenosis, periprocedural transient ischemic attack (TIA), stroke, and death.

An implementation strategy was not provided.

Not applicable: The guideline was not adapted from another source.

Society of Interventional Radiology

Standards of Practice Committee

Committee Members: Randall T. Higashida, MD; Philip M. Meyers, MD; John J. Connors, III, MD; David Sacks, MD; C.M. Strother, MD; John D. Barr, MD; Joan C. Wojak, MD; and Gary R. Duckwiler, MD

None of the authors have identified a conflict of interest.

This is the current release of the guideline.

Electronic copies: Available in Portable Document Format (PDF) from the Journal of Vascular and Interventional Radiology Web site .

Print copies: Available from the Society of Interventional Radiology, 10201 Lee Highway, Suite 500, Fairfax, VA 22030.

None available

The following is available:

• Non-surgical procedures open blocked arteries to prevent and treat stroke. Available from the Society of Interventional Radiology Web site .

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

This NGC summary was completed by ECRI Institute on August 22, 2011. The information was verified by the guideline developer on September 8, 2011. This summary was updated by ECRI Institute on April 13, 2012 following the U.S. Food and Drug Administration advisories on Statin Drugs and Statins and HIV or Hepatitis C drugs.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.