Symptomatic intracranial atherosclerosis
In medically-treated patients with 50 to 99 percent stenosis of a major intracranial artery:
= the annual risk of ischemic stroke is as high as 15 percent in any vascular territory and
= 12 percent in the territory of the stenotic artery.
= lifestyle modification (eg, exercise, smoking cessation, weight reduction, and a Mediterranean diet)
= Treat Hypertension keep systolic BP <140
= High internsity statin therapy: Atorvastatin 80 mg qd or Rosvastatin 20-40 mg qd
= recent (within 30 days) transient ischemic attack (TIA) or stroke attributed to atherosclerotic intracranial large artery stenosis of 70 to 99 percent
Use dual antiplatelet therapy with aspirin plus clopidogrel for the first 90 days
= do not recommend intracranial stenting
= recent TIA or stroke attributed to atherosclerotic intracranial large artery stenosis of 50 to 69 percent
Use aspirin monotherapy or short-term (21-day) dual antiplatelet therapy.