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Editorial
March 24/31, 2015

Endovascular Therapy for Atherosclerotic Intracranial Arterial StenosisBack to the Drawing Board

Author Affiliations
  • 1Department of Neurosciences, Medical University of South Carolina, Charleston
  • 2Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
  • 3Department of Neurology, Washington University School of Medicine, St Louis, Missouri
  • 4Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri
JAMA. 2015;313(12):1219-1220. doi:10.1001/jama.2015.1276

Atherosclerotic stenosis of the major intracranial arteries (carotid, middle cerebral, vertebral, and basilar) is one of the most common causes of stroke worldwide and is associated with a particularly high risk of recurrent stroke.1 Despite this, relatively few randomized clinical trials have evaluated different therapeutic approaches to prevent stroke in patients with intracranial arterial stenosis. The WASID (Warfarin Aspirin Symptomatic Intracranial Disease) trial demonstrated that aspirin was as effective and safer than warfarin for preventing stroke in patients with symptomatic intracranial stenosis, however, neither therapy was particularly effective, especially in patients with more severe stenosis (70%-99%) and recent symptoms.2,3

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