ESO Session Highlight – Extracranial and Intracranial Large Vessel Disease

The session Extracranial and Intracranial Large Vessel Disease was a very interesting and educative session chaired by Peter Ringleb and Nicola Sprigg.

Marcel Arnold talked about Intracranial dissections (IAD) in the carotid or vertebral artery, he described the clinical picture and neuroimaging diagnosis, which can often be difficult. He also talked about the proposed diagnostic criteria for IAD. Accorrding to Paris Concensus (2015), treatment od IAD and ischemic stroke is medicamentous, usually with aspirin; the efficacy and safety of i.v. thrombolysis is not known, but in Treatment of IICAD is according to Paris Connensus 2015, usually medically, (with aspirin), efficacy and safety of iv thrombolytic treatment is not known, but probably should not be withdrawn. In patients with IAD and SAH, treatment options should be discussed in multidisciplinary teams. Many centers consider endovascular and surgical treatments in such patients.

Bart van der Worp talked about the vertebral artery (VA) stenosis, that carries a higher risk for a reccurent stroke if it is > 50%. Detection is done by duplex ultrasound, CTA,  DSA and/or MRA (which has a highest sensitivity and specificity). He showed the diagnosis and surgery treatment for extracranial VA stenosis. There are no evidence from randomized trials. Surgery is performed in highly selected centers only, but long term benefit is uncertain. Stenting is another option, a much easier procedure, there are randomized trials for stenting of VA stenosis (VIST, VAST). The follow up of both studies showed the risk of stroke – stenting of extracranial VA carries >50% risk comparable to the carotid artery stenosis.

Leo Bonati talked about carotid artery stenosis, he showed evidenve of evidence of endarterectomy vs stenting in symptomatic and asymptomatic carotid artery stenosis. He stressed that we need to select the patients for each treatment more carefully, taking into account their overall risk factors for stroke, in order to increase their benefit.

Juan F. Arenillas talked about arterial wall imaging using MRI, while Elena Lopez Cancio delivered a lecture entitled Intracranial atherosclerotic disease:imaging and treatment.