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June 01, 2016; 6 (3) Review

Stroke due to large vessel atherosclerosis

Five new things

Erika Marulanda-Londoño and Seemant Chaturvedi
First published March 24, 2016, DOI: https://doi.org/10.1212/CPJ.0000000000000247
Erika Marulanda-Londoño
Stroke Program and Department of Neurology (EM-L, SC), University of Miami Miller School of Medicine, and Miami VA Hospital (SC), Miami, FL.
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Seemant Chaturvedi
Stroke Program and Department of Neurology (EM-L, SC), University of Miami Miller School of Medicine, and Miami VA Hospital (SC), Miami, FL.
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Stroke due to large vessel atherosclerosis
Erika Marulanda-Londoño, Seemant Chaturvedi
Neurology: Clinical Practice Jun 2016, 6 (3) 252-258; DOI: 10.1212/CPJ.0000000000000247

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Abstract

Purpose of review: Extracranial (EC) and intracranial (IC) large vessel atherosclerosis account for about 20% of ischemic stroke cases. In recent years, new treatments have emerged for treatment of both EC and IC disease.

Recent findings: The stroke rate in patients with carotid stenosis is decreasing with modern medical therapy. For patients with asymptomatic stenosis, the stroke rate is likely <1% per year. Some subsets of patients with symptomatic carotid disease benefit less from revascularization, and medical management can be considered in these patients. A second clinical trial has confirmed that aggressive medical management is the treatment of choice for IC atherosclerotic disease. Vessel wall imaging may be useful to define pathophysiology in patients with IC stenosis and could ultimately help tailor therapy, but further studies are needed. Medical therapy is preferred to stenting for patients with vertebral artery–origin stenosis.

Summary: Recent data and emerging concepts regarding large vessel atherosclerosis are provided.

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  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Received October 22, 2015.
  • Accepted January 12, 2016.
  • © 2016 American Academy of Neurology
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