Furthermore, recurrent ischemia may not cause clinical stroke events, yet cognitive and other neurological impairment may ensue ( 3). The neurological impact of ICAD is likely vastly underestimated by the incidence of recurrent stroke, as relatively mild clinical severity, involvement of secondary or less apparent functional regions of the brain and lack of continuity of care decrease reported recurrent events. As the most common etiology of ischemic stroke, effective treatment strategies for acute ischemia and secondary stroke prevention are greatly needed.
![icad neurology icad neurology](https://jnnp.bmj.com/content/jnnp/92/4/370/F2.large.jpg)
![icad neurology icad neurology](https://neurologyindia.com/articles/2019/67/2/images/ni_2019_67_2_588_258031_f1.jpg)
Recurrent stroke due to intracranial atherosclerotic disease (ICAD), the leading cause of stroke worldwide, causes an overwhelming burden of disability ( 1, 2). The evolving science of multivariable interactions in ICAD and use of big data are explored, followed by an overview of recently launched clinical trials. The temporal features of ICAD and longitudinal observation are considered with respect to management and risk factor modification. Imaging correlates are reviewed, from routine multimodal CT or MRI to advanced angiographic techniques. This thematic overview provides perspective on current definitions for arterial stenosis, symptomatic lesions and outcomes or endpoints in clinical trials. The ICAS 2019 meeting provided a roadmap for accelerating global innovation, underscoring the epidemiology, prior scientific evidence from trials, diagnostic tools or imaging, novel biomarkers, management approaches, and a broad range of treatments including many new medications, endovascular, and surgical strategies. Theranostics for ICAD incorporates an integrated diagnostic and therapeutic approach tailored to a specific individual. Challenges and concrete initiatives have emerged in the implementation of precision medicine for ICAD, focusing personalized treatment for the prevention of stroke and cognitive impairment around pathophysiology.
Icad neurology series#
In a series of patients with CeAD, we observed significant differences between VAD and ICAD in terms of clinical symptoms and radiological features. Most patients had a favourable outcome (mRS 0–2).Ĭonclusions and clinical implications.
![icad neurology icad neurology](https://www.neurologyadvisor.com/wp-content/uploads/sites/10/2019/02/arteriosclerosisg875052952_1359084.jpg)
Occlusion occurred more often in patients with VAD (69.2% vs 22.2% p = 0.013). Ischaemic stroke was more severe in patients with ICAD. Patients with VAD more often had ischaemic events (ischaemic stroke, TIA or transient blindness) (84.6% vs 44.6% p = 0.0032). Patients with ICAD presented Horner syndrome significantly more often (44.4% vs 7.6% p = 0.04). Appropriate imaging confirmed the diagnosis of CeAD. We performed a retrospective analysis of 31 patients (mean age 42.2 years) with CeAD (18 with ICAD, 13 with VAD) treated in our neurology department from 2008 to 2018. Its clinical course is highly variable, resulting in challenges in making a proper diagnosis. Cervical artery dissection (CeAD) is a major cause of cerebral ischaemia in young adults.
![icad neurology icad neurology](https://neurology.mect.cuhk.edu.hk/images/research/2021-ICAD.jpg)
To examine whether baseline characteristics, potential risk factors, clinical symptoms, radiological presentation, and long-term outcomes differ between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD).Ĭlinical rationale for study.