TY - JOUR
T1 - Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis Practice Advisory
T2 - Report of the AAN Guideline Subcommittee
AU - Turan, Tanya N.
AU - Zaidat, Osama O.
AU - Gronseth, Gary S.
AU - Chimowitz, Marc I.
AU - Culebras, Antonio
AU - Furlan, Anthony J.
AU - Goldstein, Larry B.
AU - Gonzalez, Nestor R.
AU - Latorre, Julius G.
AU - Messé, Steven R.
AU - Nguyen, Thanh N.
AU - Sangha, Rajbeer S.
AU - Schneck, Michael J.
AU - Singhal, Aneesh B.
AU - Wechsler, Lawrence R.
AU - Rabinstein, Alejandro A.
AU - Dolan O'Brien, Mary
AU - Silsbee, Heather
AU - Fletcher, Jeffrey J.
N1 - Publisher Copyright:
© American Academy of Neurology.
PY - 2022/3/22
Y1 - 2022/3/22
N2 - Background and ObjectivesTo review treatments for reducing the risk of recurrent stroke or death in patients with symptomatic intracranial atherosclerotic arterial stenosis (sICAS).MethodsThe 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 RecommendationsClinicians 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 clinical trials. Clinicians should not recommend direct bypass for stroke prevention in patients with sICAS. Clinicians should counsel patients about the risks of percutaneous transluminal angioplasty and stenting and alternative treatments if one of these procedures is being contemplated.
AB - Background and ObjectivesTo review treatments for reducing the risk of recurrent stroke or death in patients with symptomatic intracranial atherosclerotic arterial stenosis (sICAS).MethodsThe 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 RecommendationsClinicians 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 clinical trials. Clinicians should not recommend direct bypass for stroke prevention in patients with sICAS. Clinicians should counsel patients about the risks of percutaneous transluminal angioplasty and stenting and alternative treatments if one of these procedures is being contemplated.
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U2 - 10.1212/WNL.0000000000200030
DO - 10.1212/WNL.0000000000200030
M3 - Article
C2 - 35314513
AN - SCOPUS:85126898842
SN - 0028-3878
VL - 98
SP - 486
EP - 498
JO - Neurology
JF - Neurology
IS - 12
ER -