Risk of Stroke Recurrence in Patients with Intracranial Atherosclerosis Disease (ICAD) Treated with Stent versus Stent Plus Alternative Treatments: A Systematic Review

Introduction: Intracranial atherosclerotic disease (ICAD) is one of the most common causes of stroke in the world and carries the worst prognosis compared to other stroke etiologies. Impaired delivery of oxygen and glucose through the vessels altered by atherosclerosis is the basis of ischemic brain damage, excess of free radicals disrupt endothelial function. Despite modern medical management, the rates of recurrent stroke in ICAD remain elevated. New approaches are necessary for better outcomes and reducing recurrent strokes.

Methods: We used PubMed and Trip Database to research, our keywords were: "intracranial arteriosclerosis", "treatment outcome", resulting in 3,277 articles, the filters “last 5 years” and “randomized clinical trials” were applied, yielding 14 results. After reading the abstracts, duplicates and not eligible results were eliminated. 8 articles were used. Subsequent analysis was performed with Prisma.

Results: Studies comparing stent management against stent plus alternative treatment reported reduced risk of recurrent stroke in the latter group. In the CASSISS trial, medical management with or without stent showed no statistical significance in recurrent stroke risk reduction. In trials that had additional management after the stent procedure, it was found that dual antiplatelet therapy may lower the risk of stroke in patients but may increase the risk of major hemorrhage; lifestyle modifications provided better control for almost all risk factors. New treatment approaches such as Divaza and encephaloduroarteriosynangiosis (EDAS) showed promising results, with overall outcome improvement and reduced risk of stroke recurrence.

Conclusion : Several studies support that alternative treatment with or without stenting provides benefits in reducing the risk of recurrent stroke. Continued post-stent management and changes in habits and lifestyle appeared to be of high importance. Treatment for ICAD is evolving constantly, targeting alternative disease pathways such as metabolic stress, free radicals or correcting and prioritizing hemodynamical aspects indicates that we should remain aware to new pathways of treatment.