AAN Practice Advisory Addresses Prevention of Second Stroke in Patients With Intracranial Atherosclerosis

March 21, 2022—The American Academy of Neurology (AAN) announced the publication of a new practice advisory for the prevention of a second stroke in patients with intracranial atherosclerosis.

The document, “Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis Practice Advisory Report of the AAN Guideline Subcommittee,” by Tanya N. Turan, MD, et al is available in the online issue of AAN’s journal Neurology. Additionally, the advisory is endorsed by the American Heart Association/American Stroke Association, the Neurocritical Care Society, and the Society of Vascular and Interventional Neurology.

According to AAN, the advisory states that the use of medications and exercise is more beneficial in preventing a second stroke in patients with intracranial atherosclerosis than placing a stent in the blood vessel. The practice advisory looked at all available research on preventing a second stroke or death for people who had a first stroke due to intracranial atherosclerosis.

The practice advisory recommends the use of aspirin for long-term prevention of second stroke and death. If the narrowing of the arteries is severe, clopidogrel can be used in addition to aspirin for up to 90 days. The practice advisory recommends the use of statins to achieve the goal of low-density lipoprotein cholesterol < 70 mg/dL, a long-term blood pressure target < 140/90 mm Hg, and at least moderate physical activity for patients who can safely exercise.

“People who have had this type of stroke should first be started on medications to prevent blood clots, reduce blood pressure and cholesterol, and safely start increasing their physical activity as recommended by their doctors to decrease the risk of another stroke,” commented Dr. Turan in the society’s press release. “Having a stent placed in the blood vessel of the brain should not be the first option of care for most people.”

Dr. Turan added, “Reviewing all of the evidence that has accumulated over the last 2 decades, we found that the research shows that medical management is more beneficial for people as an initial treatment.” Dr. Turan, a Fellow of the AAN, is from the Medical University of South Carolina in Charleston, South Carolina.