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Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis

Practice Advisory, March 2022

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This practice advisory reviews and explains the data supporting recommendations for medical management for reducing the risk of recurrent stroke or death in patients with symptomatic intracranial atherosclerotic arterial stenosis (s-ICAS). Antithrombotics, dyslipidemic agents, and lifestyle modification can all be effective management options. Stenting should not be recommended as the initial treatment for s-ICAS. Additional research is underway to determine the effectiveness of other management approaches, including other antithrombotics and endovascular/surgical techniques.

Endorsed by the American Heart Association/American Stroke Association, the Neurocritical Care Society, and the Society of Vascular and Interventional Neurology.

Reaffirmed on April 7, 2025.

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