Is Balloon Angioplasty the Future for Intracranial Stenosis?

Intracranial atherosclerotic arterial stenosis (ICAS) is one of the most common causes of stroke worldwide and is associated with a particularly high risk of recurrent stroke. The mechanisms by which ICAS causes transient ischemic attack (TIA) or stroke include acute occlusion or artery-to-artery embolization due to plaque rupture, branch atheromatous disease wherein the large artery plaque overgrows the ostium of a perforator artery, hypoperfusion of distal territory due to low flow, or a combination of these mechanisms. Of these, hypoperfusion is one of the less common mechanisms of cerebral ischemia. Therapeutic strategies for secondary stroke prevention in patients with ICAS presenting with a TIA or stroke have included new approaches to antithrombotic therapy, risk factor management, and various surgical and endovascular procedures. Some of these efforts, such as intensive risk factor management and dual antiplatelet therapy, have resulted in incremental improvements in lowering the risk of recurrent stroke. However, stroke risk remains extremely high for many patients with this disease.