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  • Psychogios, MariosUniversity Hospital Basel (författare)

European Stroke Organisation guidelines on treatment of patients with intracranial atherosclerotic disease

  • Artikel/kapitelEngelska2022

Förlag, utgivningsår, omfång ...

  • 2022-06-03
  • SAGE Publications,2022

Nummerbeteckningar

  • LIBRIS-ID:oai:lup.lub.lu.se:e5ce246c-7ffa-4535-af3f-168ca768ea05
  • https://lup.lub.lu.se/record/e5ce246c-7ffa-4535-af3f-168ca768ea05URI
  • https://doi.org/10.1177/23969873221099715DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:art swepub-publicationtype
  • Ämneskategori:ref swepub-contenttype

Anmärkningar

  • The aim of the present European Stroke Organisation guideline is to provide clinically useful evidence-basedrecommendations on the management of patients with intracranial atherosclerotic disease (ICAD). The guidelines wereprepared following the Standard Operational Procedure of the European Stroke Organisation guidelines and accordingto GRADE methodology. ICAD represents a major cause of ischemic stroke worldwide, and patients affected by thiscondition are exposed to a high risk for future strokes and other major cardiovascular events, despite best medicaltherapy available. We identified 11 relevant clinical problems affecting ICAD patients and formulated the correspondingPopulation Intervention Comparator Outcomes (PICO) questions. The first two questions refer to the asymptomaticstage of the disease, which is being increasingly detected thanks to the routine use of noninvasive vascular imaging. Wewere not able to provide evidence-based recommendations regarding the optimal detection strategy and management ofasymptomatic ICAD, and further research in the field is encouraged as subclinical ICAD may represent a big opportunityto improve primary stroke prevention. The second block of PICOs (3–5) is dedicated to the management of acutelarge vessel occlusion (LVO) ischemic stroke caused by ICAD, a clinical presentation of this disease that is becomingincreasingly relevant and problematic, since it is associated with more refractory endovascular reperfusion procedures.An operational definition of probable ICAD-related LVO is proposed in the guideline. Despite the challenging context,no dedicated randomized clinical trials (RCTs) were identified, and therefore the guideline can only provide withsuggestions derived from observational studies and our expert consensus, such as the escalated use of glycoproteinIIb-IIIa inhibitors and angioplasty/stenting in cases of refractory thrombectomies due to underlying ICAD. The last blockof PICOs is devoted to the secondary prevention of patients with symptomatic ICAD. Moderate-level evidence wasfound to recommend against the use of oral anticoagulation as preferred antithrombotic drug, in favor of antiplatelets.Low-level evidence based our recommendation in favor of double antiplatelet as the antithrombotic treatment of choicein symptomatic ICAD patients, which we suggest to maintain during 90days as per our expert consensus. Endovasculartherapy with intracranial angioplasty and or stenting is not recommended as a treatment of first choice in high-gradesymptomatic ICAD (moderate-level evidence). Regarding neurosurgical interventions, the available evidence does notsupport their use as front line therapies in patients with high-grade ICAD. There is not enough evidence as to provideany specific recommendation regarding the use of remote ischemic conditioning in ICAD patients, and further RCTsare needed to shed light on the utility of this promising therapy. Finally, we dedicate the last PICO to the importanceof aggressive vascular risk factor management in ICAD, although the evidence derived from RCTs specifically addressingthis question is still scarce

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Brehm, AlexUniversity Hospital Basel (författare)
  • López-cancio, ElenaAsturias General Hospital (författare)
  • Marco De Marchis, GianUniversity Hospital Basel,University of Basel (författare)
  • Meseguer, ElenaHopital Bichat-Claude-Bernard AP-HP (författare)
  • Katsanos, Aristeidis HMcMaster University (författare)
  • Kremer, ChristineLund University,Lunds universitet,Neurologi, Lund,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Neurology, Lund,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital(Swepub:lu)med-ckm (författare)
  • Sporns, PeterUniversity Medical Center Hamburg-Eppendorf,University Hospital Basel (författare)
  • Zedde, MarialuisaAzienda USL-IRCCS di Reggio Emilia (författare)
  • Kobayashi, AdamCardinal Stefan Wyszyński University in Warsaw,Mazovian voivodeship hospital, Siedlce (författare)
  • Caroff, JildazHopital Bichat-Claude-Bernard AP-HP (författare)
  • Bos, DanielErasmus University Medical Center (författare)
  • Lémeret, SabrinaEuropean Stroke Organisation (författare)
  • Lal, AvtarEuropean Stroke Organisation (författare)
  • Arenillas, Juan FUniversity of Valladolid (författare)
  • University Hospital BaselAsturias General Hospital (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:European Stroke Journal: SAGE Publications2396-98812396-9873

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