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
Chimowitz MI, Derdeyn CP. Endovascular Therapy for Atherosclerotic Intracranial Arterial Stenosis: Back to the Drawing Board. JAMA. 2015;313(12):1219–1220. doi:10.1001/jama.2015.1276
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