Benign Prognosis of Asymptomatic Intracranial Stenosis

A prospective cohort study in England found that the prevalence ofasymptomatic intracranial stenosis (ICS) increased with age in patients with transient ischemic attack (TIA) and minor stroke, but did not increase the short- or medium-term risk of distal recurrent ischemic stroke in patients receiving standard medical treatment. The study included 1368 eligible patients (mean age 69.2 years; 51.2% men) with intracranial vascular imaging, 426 ICS were identified in 260 patients (19.0%): 58 (4.2%) with only symptomatic ICS, 155 (11.3%) with only asymptomatic ICS, and 47 (3.4%) with both. The prevalence of any asymptomatic ICS increased from 4.8% for patients younger than 70 years to 34.6% for patients 90 years or older and was greater than that of 50% or more asymptomatic carotid bifurcation stenosis (202 vs 105 patients). However, the 155 patients with only asymptomatic ICS had no increase in risk of ischemic stroke compared with those with no ICS (unadjusted HR, 1.03), with 8 first recurrent events (5.2%) during 506 patient-years of follow-up and 3 in the territory of the ICS (annualized risk, 0.59%). The findings,  reminiscent of the well-known carotid stenosis, suggest that the patients should be treated per standard guidelines for stroke secondary prevention, no specific additional treatments or follow-up imaging are routinely required for patients with TIA/stroke with asymptomatic ICS. Source: https://jamanetwork.com/