How to face an ICAD?
Intracranial atherosclerotic disease (ICAD) is a dynamic disease characterized by the development, progression, and complication of atherosclerotic plaques affecting major intracranial arteries. ICAD prevalence varies within population with high spread in Asian, Hispanic and African ethnicities and relatively rare manifestation among Caucasians (up to 10% of ischemic stroke) although, nevertheless, it is more common in autopsy studies[1] Therefore, considering the distribution of the world’s population, ICAD may represent a major cause of stroke and vascular cognitive impairment globally[2].
Step-by-step technique and expert’s recommendation:
Can be used especially as a pre-stenting strategy:
Can be used when:
Technical concerns:
Description of the technique: size of the chosen stent should be that one of a distal part of the vessel. After the stent placement, the angioplasty with the bigger balloon in proximal part of the stent is performed. The result is two different diameters within the stent.
Its usage in intracranial arteries is limited due to potential danger with balloon overdilatation.
ICAD can be the underlying cause of large vessel occlusion in stroke patients undergoing mechanical thrombectomy and its diagnosis can be very challenging. Proper antiaggregation is crucial but whenever insufficient, you should consider stabilize the lesion with angioplasty and/or stent placement.
Literature: