Symptomatic intracranial stenosis: best medical treatment vs. intracranial stenting

Purpose of review The high risk of stroke and death in patients with symptomatic intracranial stenosis despite medical therapy has spurred interest in endovascular treatment approaches. Recent findings Three stents have been designed for the treatment of intracranial stenosis, and two, the Wingspan and Neurolink Stent Systems, have been evaluated in single-arm trials. The trials and two prospective registries evaluating the Wingspan Stent System suggest that stenting is most likely to be beneficial in patients with the highest risk of stroke on medical therapy, namely those with 70-99% stenosis. Summary Randomized treatment trials comparing stenting with medical therapy in symptomatic intracranial stenosis need to target the patients at highest risk of recurrent vascular events on medical therapy. Such trials are in progress. Ongoing trials in Asia are also assessing medical therapies, including cilostazol, in patients with intracranial stenosis.