Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis Practice Advisory

作者：Tanya N. Turan, Osama O. Zaidat, Gary Gronseth, Marc I. Chimowitz, Antonio Culebras, Anthony J. Furlan, Larry B. Goldstein, Nestor R. Gonzalez, Julius Gene Latorre, Steven R. Messé, Thanh N. Nguyen, Rajbeer Singh Sangha, Michael Schneck, Aneesh B. Singhal, Lawrence R. Wechsler, Alejandro A. Rabinstein, Mary Dolan O’Brien, Heather M. Silsbee, Jeffrey J. Fletcher · 发表于：Neurology · 年份：2022 · DOI：10.1212/wnl.0000000000200030 · 被引用次数：96 · 研究领域：Cerebrovascular and Carotid Artery Diseases、Acute Ischemic Stroke Management、Intracranial Aneurysms: Treatment and Complications

Background and Objectives To review treatments for reducing the risk of recurrent stroke or death in patients with symptomatic intracranial atherosclerotic arterial stenosis (sICAS). Methods The development of this practice advisory followed the process outlined in the American Academy of Neurology Clinical Practice Guideline Process Manual, 2011 Edition, as amended. The systematic review included studies through November 2020. Recommendations were based on evidence, related evidence, principles of care, and inferences. Major Recommendations Clinicians should recommend aspirin 325 mg/d for long-term prevention of stroke and death and should recommend adding clopidogrel 75 mg/d to aspirin for up to 90 days to further reduce stroke risk in patients with severe (70%–99%) sICAS who have low risk of hemorrhagic transformation. Clinicians should recommend high-intensity statin therapy to achieve a goal low-density lipoprotein cholesterol level <70 mg/dL, a long-term blood pressure target of <140/90 mm Hg, at least moderate physical activity, and treatment of other modifiable vascular risk factors for patients with sICAS. Clinicians should not recommend percutaneous transluminal angioplasty and stenting for stroke prevention in patients with moderate (50%–69%) sICAS or as the initial treatment for stroke prevention in patients with severe sICAS. Clinicians should not routinely recommend angioplasty alone or indirect bypass for stroke prevention in patients with sICAS outside clinica...