Intracranial angioplasty and stenting: Modern approaches to revascularization for atherosclerotic disease

The tremendous importance of intracranial atherosclerotic disease cannot be overestimated. Traditionally, patients with this condition have been managed by neurologists and internists. As the inadequacy of medical therapy has come to light, neurosurgeons and neurointerventionists have begun to pay more attention to this highly prevalent problem. The newfound interest in this disease is well justified: intracranial atherosclerotic stenosis is more prevalent and more dangerous than unruptured cerebral aneurysms and arteriovenous malformations put together [15]. It is essential that we maintain our focus regarding the relative frequency and importance of the diseases that we treat as physicians so as to deliver the best therapies to the largest number of patients. Over the next few years, a rigorous assessment of the efficacy of coated stents compared with medical therapy for the treatment of intracranial atherosclerotic disease will provide another step toward the goal of adequately managing this difficult problem.