Cerebral Arteriosclerosis: Treatment, Prevention & Stroke Risk Reduction

Cerebral arteriosclerosis (intracranial atherosclerosis) = progressive thickening/stenosis of brain arteries. No cure; management targets stroke prevention and symptom control.

Evidence-Based Medical Therapy

• Antiplatelets: Aspirin 81–325 mg/day (first-line). Clopidogrel if aspirin-intolerant. Dual antiplatelet (aspirin + clopidogrel × 90 days) only for recent TIA/stroke (CHANCE/POINT trials).
• Anticoagulation: Not routine for atherosclerosis alone; reserved for cardioembolic sources (AFib, mechanical valve).
• Statins: High-intensity (atorvastatin 40–80 mg, rosuvastatin 20–40 mg) to LDL <70 mg/dL. Stabilizes plaque, reduces stroke/MI.
• BP Control: Target <130/80 mmHg (SPRINT-MIND). ACEi/ARB, thiazide, CCB preferred.
• Diabetes: HbA1c <7%; SGLT2i/GLP-1 RA if CVD/CKD.

Lifestyle Pillars

• Mediterranean/DASH diet (high fiber, omega-3, low sodium/sat fat)
• 150 min/week moderate aerobic + 2× resistance training
• Smoking cessation (↑stroke risk 2–4×)
• Alcohol ≤1 drink/day (women), ≤2 (men)
• Weight management (BMI 18.5–24.9)

Interventional Options

• Carotid endarterectomy (CEA): Symptomatic stenosis 50–99% (NASCET) or asymptomatic 60–99% (CREST) with low surgical risk.
• Carotid stenting (CAS): Alternative for high-surgical-risk; higher periprocedural stroke risk.
• Intracranial stenting: Not recommended for asymptomatic; only in trials or recurrent stroke on maximal meds (SAMMPRIS: medical therapy superior).

Symptom Management

Cognitive rehab, vestibular therapy for dizziness, headache prophylaxis. Multidisciplinary clinic (neurology, vascular surgery, lipidology) optimizes outcomes.