AAN issues new guidance on preventing second stroke in patients with intracranial atherosclerosis

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In patients with intracranial atherosclerosis, the use of medications and exercise is more beneficial in preventing a second stroke than placing a stent in the blood vessel, according to a new practice advisory issued by the American Academy of Neurology (AAN). The practice advisory is published in an online issue of Neurology.

Intracranial atherosclerosis—a build-up of cholesterol plaque in the arteries in the brain—can, over time, cause a narrowing of the blood vessels, and is associated with high blood pressure, high cholesterol, diabetes and smoking.

The recent practice advisory looked at all available research on preventing a second stroke or death for people who had a first stroke due to intracranial atherosclerosis, which is one of the most common causes of stroke worldwide and is associated with a high risk of having another stroke, according to the AAN.

“People who have had this type of stroke should first be started on medications to prevent blood clots, [and] reduce blood pressure and cholesterol, and safely start increasing their physical activity as recommended by their doctors to decrease the risk of another stroke,” said practice advisory author Tanya Turan (Medical University of South Carolina, Charleston, USA). “Having a stent placed in the blood vessel of the brain should not be the first option of care for most people.”

Turan added that medical management through medication and exercise, and placing a stent to open a narrowing in the blood vessels, have been the two approaches developed for preventing a second stroke in these patients.

“Reviewing all of the evidence that has accumulated over the last two decades, we found that the research shows that medical management is more beneficial for people as an initial treatment,” she further stated.

The practice advisory recommends the use of aspirin for long-term prevention of second stroke and death. If the narrowing of the arteries is severe, it notes, the drug clopidogrel can be used in addition to aspirin for up to 90 days. The practice advisory also recommends the use of statins to achieve the goal of low-density lipoprotein cholesterol of less than 70mg/dL, a long-term blood pressure target of less than 140/90mmHg, and at least moderate physical activity for people who can safely exercise.


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