Sequential asymptomatic intracranial atherosclerosis (ICAD) - to be treated, or not

• 57-year-old male patient
• Recurrent ischemic CVA
• Right hemiparesis
• 3 episodes in 3 months
• Gradual recovery
• On antiplatelets – Eco 150 mg, Clop 75 mg & statins

• Accumulation of disease burden
• Memory loss, depression
• mRS 3 now

• Best medical management (eco 300 clop 150 high statins, exercise) & wait for stroke
• Active intervention - two sessions / both at the same time - distal first or proximal first

R EJV -> Facial vein navigation

In use: 014” exchange length microwire / In use: coronary balloon 2.25 x 10 RX SC

In use : coronary balloon 2.25 x 10 RX, SC 

In use : coronary DES RX (Zotarolimus) 4 x 8 mm

In use: coronary balloon 2.25 x 10 RX, SC 

• Now on BMM,
• No recurrence
• Improvement in memory loss and neuropsychiatric symptoms

Key address

• Sequential ICAD – proximal or distal first?
• Asymptomatic critical ICAD / precious artery – beyond guidelines
• ICAD treatment for neuropsychiatric symptoms, depression and memory loss