#WeekendLecture
Intracranial Atherosclerotic Disease #ICAD
#ICAD leads to changes ranging from minor wall thickening to #hemodynamically significant luminal stenosis and is one of the most #common causes of #stroke worldwide
ahajournals.org/doi/10.1161/CI…
🧵
#WeekendLecture
#ICAD
✅10% of stroke, based on autopsy studies
bit.ly/3v6Lhrd
✅More prevalent in #African Americans, #Hispanics, and #Asians as compared with whites
bit.ly/3AuSiDt
Other risk factors in table
#WeekendLecture
#ICAD
In postmortem studies
👉degree of luminal #stenosis
👉% of the plaques containing >40% #lipid area
👉prevalence of intraplaque #hemorrhage, #neovasculature and #thrombus,
were higher in those #plaques associated with #infarct
🔹karger.com/Article/Abstra…
#WeekendLecture
#ICAD
Mechanism of stroke in patients with #ICAD
✅Thrombotic occlusion
✅Artery to artery embolism
✅Hemodynamic impair
✅Branch atheromatous disease
j-stroke.org/journal/view.p…
#WeekendLecture
#ICAD
ICAD can be diagnosed by #CTA, #TCD, #MRA or conventional #angiography
👉n.neurology.org/content/68/24/…
👉ajnr.org/content/26/5/1…
Check the table for strengths and limitations ⤵️
#WeekendLecture
#ICAD
High-resolution vessel wall MRI (vwMRI) of the intracranial arteries is an emerging diagnostic imaging technique
🔹link.springer.com/article/10.100…
🔹j-stroke.org/journal/view.p…
Today it is a useful tool to evaluate ICAD, differential diagnosis, even follow up
#WeekendLecture
#ICAD
#Differential #diagnosis of Intracranial #Atherosclerotic Disease
From: practicalneurology.com/articles/2019-…
#WeekendLecture
#ICAD
From publication of #SAMMPRIS results, #ICAD management is based primarily in medical treatment including #DAPT, statins, and lifestyle modifications
ahajournals.org/doi/full/10.11…
#WeekendLecture
#ICAD
Recent trails like #WEAVE, WOVEN and CASSISS have shown the safety of #PTAS with⬇️ rate of stroke and death versus aggressive medical treatment with #refined inclusion/exclusion #criteria and experienced operators
strokejournal.org/article/S1052-…
#WeekendLecture
#ICAD
Current #research: #imaging and laboratory-based #biomarkers to assist with #stratifying pts w/higher recurrent stroke risk and to select for targeted medical or endovascular treatments
#BIOSIS ⬆️PAI-1 & hrCRP👉⬆️stroke risk in ICAD
ahajournals.org/doi/10.1161/st…
#WeekendLecture
#ICAD
#MyRIAD contemporary cohort of symptomatic ICAD w/intensive medical management
Risk of recurrent clinical stroke: 5% at 6-8w
Unable to define a higher risk group based on abnormal hemodynamic & plaque instability imaging biomarkers
strokejournal.org/article/S1052-…
#WeekendLecture
#ICAD
☝️There are a few ongoing studies on angioplasty/stenting
👉Others looking for other medical strategies, like CATIS-ICAD (ASA +/- low dose #rivaroxaban): phri.ca/research/catis…
or #alirocumab (PCSK9 inhibitor): clinicaltrials.gov/ct2/show/NCT05…
#WeekendLecture
#ICAD
✅ICAD is still associated with the highest rates of recurrent stroke of any stroke subtype
✅Future research should look for optimal biomarkers
✅Current management should probably be tailored to the underlying stroke mechanism (ie: embolic vs hemodynamic)
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