Medical Treatment of Intracranial Atherosclerosis: An Update
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For patients with symptomatic intracranial atherosclerosis (ICAS), antithrombotic agents are the mainstay of therapy. Anticoagulation (warfarin) is not widely used since it is not more effective than aspirin and carries a high risk of bleeding. New oral anticoagulants are showing promise, but their use has not been investigated in appropriate clinical trials. Since the recurrent stroke risk is high with aspirin monotherapy, dual antiplatelets are considered in the early stage of symptomatic ICAS. Based on the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) and Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) results, aspirin plus clopidogrel has been recommended. However, this combination was not superior to aspirin monotherapy in patients with ICAS in the CHANCE substudy. Progression of ICAS is common, and it is associated with recurrent strokes. In the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS) study, aspirin plus cilostazol was more effective than aspirin monotherapy in preventing progression. The TOSS II trial showed that the overall change in stenosis was better with aspirin plus cilostazol than with aspirin plus clopidogrel. Aside from antithrombotic therapy, risk factor management is critical for secondary prevention, and high blood pressure is clearly linked to recurrent stroke. However, blood pressure may have to be cautiously managed in the early stage of stroke. Considering that ICAS is the major cause of stroke worldwide, further investigations are needed to establish optimal management strategies for patients with ICAS.
Abstract
For patients with symptomatic intracranial atherosclerosis (ICAS), antithrombotic agents are the mainstay of therapy. Anticoagulation (warfarin) is not widely used since it is not more effective than aspirin and carries a high risk of bleeding. New oral anticoagulants are showing promise, but their use has not been investigated in appropriate clinical trials. Since the recurrent stroke risk is high with aspirin monotherapy, dual antiplatelets are considered in the early stage of symptomatic ICAS. Based on the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) and Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) results, aspirin plus clopidogrel has been recommended. However, this combination was not superior to aspirin monotherapy in patients with ICAS in the CHANCE substudy. Progression of ICAS is common, and it is associated with recurrent strokes. In the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS) study, aspirin plus cilostazol was more effective than aspirin monotherapy in preventing progression. The TOSS II trial showed that the overall change in stenosis was better with aspirin plus cilostazol than with aspirin plus clopidogrel. Aside from antithrombotic therapy, risk factor management is critical for secondary prevention, and high blood pressure is clearly linked to recurrent stroke. However, blood pressure may have to be cautiously managed in the early stage of stroke. Considering that ICAS is the major cause of stroke worldwide, further investigations are needed to establish optimal management strategies for patients with ICAS.
참고문헌 (63)
- 김종성, "Research on Intracranial Atherosclerosis from the East and West: Why Are the Results Different?", 대한뇌졸중학회지, 16(3), pp.105~113 (2014), 대한뇌졸중학회[DOI]
- Kern R, "Stroke recurrences in patients with symptomatic vs asymptomatic middle cerebral artery disease", Neurology, 65, pp.859~864 (2005)
- Mazighi M, "Prospective study of symptomatic atherothrombotic intracranial stenoses: the GESICA study", Neurology, 66, pp.1187~1191 (2006)
- Chimowitz MI, "Stenting versus aggressive medical therapy for intracranial arterial stenosis", N Engl J Med, 365, pp.993~1003 (2011)
- Jung JM, "Predictors of recurrent stroke in patients with symptomatic intracranial arterial stenosis", Stroke, 43, pp.2785~2787 (2012)
- Chimowitz MI, "Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis", N Engl J Med, 352, pp.1305~1316 (2005)
- Holmstedt CA, "Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment", Lancet Neurol, 12, pp.1106~1114 (2013)
- Koo J, "The latest information on intracranial atherosclerosis:diagnosis and treatment", Interv Neurol, 4, pp.48~50 (2015)
- 방오영, "Intracranial Atherosclerosis: Current Understanding and Perspectives", 대한뇌졸중학회지, 16(1), pp.27~35 (2014), 대한뇌졸중학회[DOI]
- Leung TW, "Management of patients with symptomatic intracranial atherosclerosis", Int J Stroke, 1, pp.20~25 (2006)
- Qureshi AI, "Intracranial atherosclerotic disease: an update", Ann Neurol, 66, pp.730~738 (2009)
- 이진수, "Diagnostic and Therapeutic Strategies for Acute Intracranial Atherosclerosis-related Occlusions", 대한뇌졸중학회지, 19(2), pp.143~151 (2017), 대한뇌졸중학회[DOI]
- Genton E, "XIV. Cerebral ischemia: the role of thrombosis and of antithrombotic therapy. Study group on antithrombotic therapy", Stroke, 8, pp.150~175 (1977)
- Fox KA, "Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome: the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) trial", Circulation, 110, pp.1202~1208 (2004)
- Steinhubl SR, "Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial", JAMA, 288, pp.2411~2420 (2002)
- Markus HS, "Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic carotid Stenosis (CARESS) trial", Circulation, 111, pp.2233~2240 (2005)
- Wang Y, "Clopidogrel with aspirin in acute minor stroke or transient ischemic attack", N Engl J Med, 369, pp.11~19 (2013)
- Amarenco P, "High-dose atorvastatin after stroke or transient ischemic attack", N Engl J Med, 355, pp.549~559 (2006)
- Liu L, "Dual antiplatelet therapy in stroke and ICAS: subgroup analysis of CHANCE", Neurology, 85, pp.1154~1162 (2015)
- Wang Y, "Association between cyp2c19 loss-of-function allele status and efficacy of clopidogrel for risk reduction among patients with minor stroke or transient ischemic attack", JAMA, 316, pp.70~78 (2016)
- Robless P, "Cilostazol for peripheral arterial disease", Cochrane Database Syst Rev, (1), pp.CD003748~ (2007)
- Thompson PD, "Meta-analysis of results from eight randomized, placebo-controlled trials on the effect of cilostazol on patients with intermittent claudication", Am J Cardiol, 90, pp.1314~1319 (2002)
- Douglas JS Jr, "Coronary stent restenosis in patients treated with cilostazol", Circulation, 112, pp.2826~2832 (2005)
- Uchiyama S, "Stroke prevention by cilostazol in patients with atherothrombosis: meta-analysis of placebo-controlled randomized trials", J Stroke Cerebrovasc Dis, 18, pp.482~490 (2009)
- Kwon SU, "Cilostazol prevents the progression of the symptomatic intracranial arterial stenosis: the multicenter double-blind placebo-controlled trial of cilostazol in symptomatic intracranial arterial stenosis", Stroke, 36, pp.782~786 (2005)
- Kwon SU, "Efficacy and safety of combination antiplatelet therapies in patients with symptomatic intracranial atherosclerotic stenosis", Stroke, 42, pp.2883~2890 (2011)
- Wong KS, "Progression of middle cerebral artery occlusive disease and its relationship with further vascular events after stroke", Stroke, 33, pp.532~536 (2002)
- Arenillas JF, "Progression and clinical recurrence of symptomatic middle cerebral artery stenosis: a long-term follow-up transcranial Doppler ultrasound study", Stroke, 32, pp.2898~2904 (2001)
- Schömig A, "Ticagrelor--is there need for a new player in the antiplatelet-therapy field?", N Engl J Med, 361, pp.1108~1111 (2009)
- Spence JD, "Recent advances in preventing stroke recurrence", F1000Res, 6, pp.1017~ (2017)
- Johnston SC, "Ticagrelor versus aspirin in acute stroke or transient ischemic attack", N Engl J Med, 375, pp.35~43 (2016)
- Amarenco P, "Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: a subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial", Lancet Neurol, 16, pp.301~310 (2017)
- Wang Y, "Ticagrelor in acute stroke or transient ischemic attack in Asian patients: from the SOCRATES trial (acute stroke or transient ischemic attack treated with aspirin or ticagrelor and patient outcomes)", Stroke, 48, pp.167~173 (2017)
- Chackalamannil S, "Thrombin receptor (protease activated receptor-1) antagonists as potent antithrombotic agents with strong antiplatelet effects", J Med Chem, 49, pp.5389~5403 (2006)
- Morrow DA, "Vorapaxar in the secondary prevention of atherothrombotic events", N Engl J Med, 366, pp.1404~1413 (2012)
- Morrow DA, "Efficacy and safety of vorapaxar in patients with prior ischemic stroke", Stroke, 44, pp.691~698 (2013)
- Kim JS, "Risk factors and stroke mechanisms in atherosclerotic stroke: intracranial compared with extracranial and anterior compared with posterior circulation disease", Stroke, 43, pp.3313~3318 (2012)
- Turan TN, "Risk factors associated with severity and location of intracranial arterial stenosis", Stroke, 41, pp.1636~1640 (2010)
- Leung TW, "Evolution of intracranial atherosclerotic disease under modern medical therapy", Ann Neurol, 77, pp.478~486 (2015)
- Turan TN, "Relationship between blood pressure and stroke recurrence in patients with intracranial arterial stenosis", Circulation, 115, pp.2969~2975 (2007)
- 박종호, "Association of Systolic Blood Pressure with Progression of Symptomatic Intracranial Atherosclerotic Stenosis", 대한뇌졸중학회지, 19(3), pp.304~311 (2017), 대한뇌졸중학회
- Oh MS, "Modest blood pressure reduction with valsartan in acute ischemic stroke: a prospective, randomized, open-label, blinded-end-point trial", Int J Stroke, 10, pp.745~751 (2015)
- Kim JT, "MRI findings may predict early neurologic deterioration in acute minor stroke or transient ischemic attack due to intracranial atherosclerosis", Eur Neurol, 64, pp.95~100 (2010)
- Liu D, "Early magnetic resonance imaging predicts early neurological deterioration in acute middle cerebral artery minor stroke", J Stroke Cerebrovasc Dis, 25, pp.469~474 (2016)
- Shin HK, "Mild induced hypertension improves blood flow and oxygen metabolism in transient focal cerebral ischemia", Stroke, 39, pp.1548~1555 (2008)
- Hillis AE, "Reperfusion of specific brain regions by raising blood pressure restores selective language functions in subacute stroke", Brain Lang, 79, pp.495~510 (2001)
- Hillis AE, "A pilot randomized trial of induced blood pressure elevation: effects on function and focal perfusion in acute and subacute stroke", Cerebrovasc Dis, 16, pp.236~246 (2003)
- Lonn E, "Effects of ramipril and vitamin E on atherosclerosis: the study to evaluate carotid ultrasound changes in patients treated with ramipril and vitamin E (SECURE)", Circulation, 103, pp.919~925 (2001)
- Stone NJ, "2013 ACC", AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology, Circulation, pp.2014, 129(25 Suppl 2)[DOI]
- Kernan WN, "Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2014, pp.45, 2160~2236
- Kim JS, "Location of cerebral atherosclerosis:why is there a difference between East and West?", Int J Stroke, 11, pp.1~12 (2016)
- Kim HJ, "Effect of statin on progression of symptomatic intracranial atherosclerosis", Can J Neurol Sci, 39, pp.801~806 (2012)
- Zhou P, "Efficacy and safety of intensive statin therapy in Chinese patients with atherosclerotic intracranial arterial stenosis: a single-center, randomized, single-blind, parallel-group study with one-year follow-up", Clin Neurol Neurosurg, 120, pp.6~13 (2014)
- Ryoo S, "Differential vascular pathophysiologic types of intracranial atherosclerotic stroke:a high-resolution wall magnetic resonance imaging study", Stroke, 46, pp.2815~2821 (2015)
- Chung JW, "Echoing plaque activity of the coronary and intracranial arteries in patients with stroke", Stroke, 47, pp.1527~1533 (2016)
- Chung JW, "Previous statin use and high-resolution magnetic resonance imaging characteristics of intracranial atherosclerotic plaque: the intensive statin treatment in acute ischemic stroke patients with intracranial atherosclerosis study", Stroke, 47, pp.1789~1796 (2016)
- Young Jun Choi, "Vessel Wall Imaging of the Intracranial and Cervical Carotid Arteries", 대한뇌졸중학회지, 17(3), pp.238~255 (2015), 대한뇌졸중학회
- Ahn SH, "Isolated MCA disease in patients without significant atherosclerotic risk factors: a high-resolution magnetic resonance imaging study", Stroke, 46, pp.697~703 (2015)
- Kuroda S, "Moyamoya disease: current concepts and future perspectives", Lancet Neurol, 7, pp.1056~1066 (2008)
- Huang YC, "Cervicocranial arterial dissection: experience of 73 patients in a single center", Surg Neurol, 72(Suppl 2), pp.S20~S27 (2009)
- Cheng MK, "A review of cerebrovascular surgery in the People’s Republic of China", Stroke, 13, pp.249~255 (1982)
- Kim YJ, "Nonatheroscleotic isolated middle cerebral artery disease may be early manifestation of moyamoya disease", Stroke, 47, pp.2229~2235 (2016)
- Wong KS, "Stroke mechanisms", Front Neurol Neurosci, 40, pp.58~71 (2016)