Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Intracranial atherosclerosis: Causes of ischemic stroke, diagnosis, and treatment

Full Text:


The paper reviews the literature on the identification of the causes of ischemic stroke and transient ischemic attacks in intracranial atherosclerosis. Symptomatic intracranial atherosclerosis is the cause of an ischemic focus in not only the cortical and subcortical structures due to hypoperfusion or arterio-arterial embolism, but also in the deep structures of the cerebral hemispheres and brainstem. Major artery dolichoectasia may make an accurate diagnosis and treatment choice difficult.

Progress in the treatment of patients with symptomatic intracranial atherosclerosis depends on the availability of current brain and vessel imaging techniques and cranial artery angioplasty and stenting methods. The efficiency of aggressive medical prevention, primarily blood pressure reduction and different combinations of antiplatelet drugs, is being intensively investigated.

About the Authors

V.A Sorokoumov
I.P. Pavlov Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg, 6–8, Lev Tolstoy St., Saint Petersburg 197022
Russian Federation

A.V. Savello
S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation, Saint Petersburg; 6, Academician Lebedev St., Saint Petersburg 194044
Russian Federation


1. Warlow C, Rinkel G, Hankey GJ, et al. Stroke: Practical Management, 3rd ed. Oxford: Blackwell Publishing Ltd; 2008. p. 1008.

2. Arenillas JF. Intracranial atherosclerosis: current concepts. Stroke. 2011 Jan;42 (1 Suppl):S20–3. DOI:

3. Turan TN, Cotsonis G, Lynn MJ, et al. Intracranial stenosis: impact of randomized trials on treatment preferences of US neurologists and neurointerventionists. Cerebrovasc dis. 2014;37(3):203–11. DOI:


5. Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2011 Jan;42(1):227–76. DOI:

6. Верещагин НВ. Патология головного мозга при атеросклерозе и артериальной гипертонии. Москва: Медицина; 1997. 288 p. [Vereshchagin NV. Patologiya golovnogo mozga pri ateroskleroze i arterial'noi gipertonii [Brain pathology at atherosclerosis and an arterial hypertension]. Moscow: Meditsina; 1997. 288 p.]

7. Werring DJ. Cerebral microbleeds: pathophysiology to clinical practice. Cambridge, UK; New York: Cambridge University Press; 2011. xiii, 183 p.

8. Markus H. EFNS Florence 2009 Teaching Course 3: Cerebral small vessel disease – a clinical update; [cited 2014 16.07.2014]. Available from: php?cid=&sid=&kolloquiumID=163

9. Marks MP, Wojak JC, Al-Ali F, et al. Angioplasty for symptomatic intracranial stenosis: clinical outcome. Stroke. 2006 Apr;37(4):1016–20. DOI:

10. Qureshi AI, Hussein HM, El-Gengaihy A, et al. Concurrent comparison of outcomes of primary angioplasty and of stent placement in high-risk patients with symptomatic intracranial stenosis. Neurosurgery. 2008 May;62(5):1053–60. DOI:

11. Zaidat OO, Klucznik R, Alexander MJ, et al. The NIH registry on use of the Wingspan stent for symptomatic 70–99% intracranial arterial stenosis. Neurology. 2008 Apr 22;70(17): 1518–24. DOI:

12. Vajda Z, Gü the T, Perez MA, et al. Prevention of intracranial in-stent restenoses: predilatation with a drug eluting balloon, followed by the deployment of a self-expanding stent. Cardiovasc Intervent Radiol. 2013 Apr;36(2):346–52. DOI:

13. Groschel K, Schnaudigel S, Pilgram SM, et al. A systematic review on outcome after stenting for intracranial atherosclerosis. Stroke. 2009 May;40(5):e340–7. DOI:

14. Gupta R, Al-Ali F, Thomas AJ, et al. Safety, feasibility, and short-term follow-up of drugeluting stent placement in the intracranial and extracranial circulation. Stroke. 2006 Oct;37(10):2562–6. DOI:

15. Chimowitz MI, Lynn MJ, Derdeyn C, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011 Sep 15;365(11):993–1003. DOI:

16. Abou-Chebl A, Steinmetz H. Critique of «Stenting versus aggressive medical therapy for intracranial arterial stenosis» by Chimowitz et al in the new England Journal of Medicine. Stroke. 2012 Feb;43(2):616–20. DOI:

17. Al Hasan M, Murugan R. Stenting versus aggressive medical therapy for intracranial arterial

18. stenosis: more harm than good. Crit Care. 2012 May 9;16(3):310. DOI:

19. Chaudhry SA, Watanabe M, Qureshi AI. The new standard for performance of intracranial angioplasty and stent placement after Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) Trial. AJNR Am J Neuroradiol. 2011 Dec;32(11):E214. DOI:

20. Tang CW, Chang FC, Chern CM, et al. Stenting versus medical treatment for severe symptomatic intracranial stenosis. AJNR Am J Neuroradiol. 2011 May;32(5):911–6. DOI:

21. Kurre W, Berkefeld J, Brassel F. In-hospital complication rates after stent treatment of 388 symptomatic intracranial stenoses: results from the INTRASTENT multicentric registry. Stroke. 2010 Mar;41(3):494–8. DOI:

22. Sacco RL, Adams R, Albers G, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart

23. Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006 Feb;37(2):577–617. DOI:

24. Qureshi AI, Feldmann E, Gomez CR, et al. Consensus conference on intracranial atherosclerotic disease: rationale, methodology, and results. J Neuroimaging. 2009 Oct;19 Suppl 1:1S-10S. DOI: 10.1111/j.1552-6569.2009.00414.x.

25. Meyers PM, Schumacher HC, Higashida RT, et al. Indications for the performance of intracranial endovascular neurointerventional procedures. A scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and

26. Interdisciplinary Council on Quality of Care and Outcomes Research. J Neurointerv Surg. 2010 Jun;2(2):177–88.

27. Hofmeijer J, Amelink GJ, Algra A, et al. Hemicraniectomy after middle cerebral artery infarction with life-threatening Edema trial (HAMLET). Protocol for a randomised controlled trial of decompressive surgery in spaceoccupying hemispheric infarction. Trials. 2006;7:29. DOI:

28. Juttler E, Schwab S, Schmiedek, et al. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke. 2007 Sep;38(9):2518–25. DOI:

29. Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet neurology. 2007 Mar;6(3):215–22.DOI:

30. Neugebauer H, Heuschmann PU, Jü ttler E, et al. DEcompressive Surgery for the Treatment

31. of malignant INfarction of the middle cerebral arterY - Registry (DESTINY-R): design and protocols. BMC neurology. 2012;12:115. DOI:

32. Juttler E, Bö sel J, Amiri H, et al. DESTINY II: DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY II. Int J Stroke. 2011 Feb;6(1):79–86.

33. Heros RC. Surgical treatment of cerebellar infarction. Stroke. 1992 Jul;23(7):937–8. DOI:

34. Пизова НВ. Амбулаторное ведение больных после тяжелого инсульта с деменцией. Неврология, нейропсихиатрия, психосоматика. 2013;(4):78–83. [Pizova NV. Outpatient management after severe stroke with dementia. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;(4):78–83. (In Russ.)]. DOI:

35. Парфенов ВА. Неврологические аспекты недержания мочи у пожилых людей. Неврология, нейропсихиатрия, психосоматика. 2013;(1):34–8. [Parfenov VA. Neurological aspects of urinary incontinence in the elderly. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;(1):34–8. (In Russ.)]. DOI:

36. -2395.

37. Benavente OR, White CL, Pearce L, et al. The Secondary Prevention of Small Subcortical Strokes (SPS3) study. Int J Stroke. 2011Apr;6(2):164–75.

38. National clinical guideline for stroke, 4th ed. London: Royal College of Physicians; 2012.

For citation:

Sorokoumov V., Savello A. Intracranial atherosclerosis: Causes of ischemic stroke, diagnosis, and treatment. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(2S):50-55. (In Russ.)

Views: 1131

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)