What is your approach to the management of asymptomatic intracranial atherosclerosis discovered during the workup of an acute stroke?

Topics: Neurology • Vascular Neurology

Does it influence your choice of antithrombotic therapy? Do you perform serial follow-up imaging?

Answer from: at Academic Institution

I would maximize the treatment of vascular risk factors such as hypertension, elevated cholesterol, and diabetes. The patient will be taking an antithrombotic medication for the acute stroke so that will also reduce the risk of stroke related to ICAD.

Comments

at UPMC
I agree. We often forget (moi aussi) that there ar...

Answer from: at Academic Institution

I agree with Dr. @Fisher. If they're young or the amount of athero seems excessive, I may also check Lp(a). I also prescribe long-term cilostazol (100 mg BID) in addition to aspirin or clopidogrel (e.g., CSPS.com) in select patients whom I view to be at higher risk. This may well qualify as one.

Answer from: at Academic Institution

I would maximize the management of vascular risk factors and have the patient take aspiirn

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