The 2023 Taiwan Stroke Society Guidelines for the management of patients with intracranial atherosclerotic disease

Sep 29, 2026

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Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke, particularly in Asian populations, with high risks of recurrent stroke and cardiovascular comorbidities. The 2023 Taiwan Stroke Society guidelines provide updated evidence-based recommendations for diagnosis and management of ICAD developed through consensus meetings. Recommendations include classes and levels of evidence approved by all members. The document covers six topics, spanning intensive medical care, nonpharmacological measures, and endovascular and surgical treatment approaches.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages18

Reading Time45 min

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Abstract

Introduction

Scope and target population

Guideline structure and six topic coverage

J Chin MedAssoc GUIDELINES The 2023 Taiwan Stroke Society Guidelines for the management of patients with intracranial atherosclerotic disease Chun-Jen Lina, Chih-Ping Chunga, Nien-Chen Liaob, Po-Lin Chenb, Nai-Fang Chia, Yen-Jun Laic, Chih-Wei Tangd, Chia-Hung Wue, Feng-Chi Change, Chao-Bao Luoe, Li-Yu Fayf, Chun-Fu Linf, Chung-Hsing Choug, Tsong-Hai Leeh, Jiunn-Tay Leeg, Jiann-Shing Jengi, I-Hui Leea,* , Taiwan Stroke Society Intracranial Atherosclerotic Disease Guidelines Consensus Group aDepartment of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bDepartment of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; cRadiology Department, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, ROC; dNeurology Department and Stroke Center, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, ROC; eDepartment of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; fDepartment of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; gNeurology Department, Tri-Service General Hospital, Taipei, Taiwan, ROC; hDepartment of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC; iDepartment of Neurology and Stroke Center, National Taiwan University Hospital, Taipei, Taiwan, ROC Abstract: Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke, especially in Asian populations, which has a high risk of recurrent stroke and cardiovascular comorbidities. The present guidelines aim to provide updated evidencebased recommendations for diagnosis and management of patients with ICAD. Taiwan Stroke Society guideline consensus group developed recommendations for management of patients with ICAD via consensus meetings based on updated evidences. Each proposed class of recommendation and level of evidence was approved by all members of the group. The guidelines cover six topics, including (1) epidemiology and diagnostic evaluation of ICAD,(2) nonpharmacological management of ICAD,(3) medical therapy for symptomatic ICAD,(4) endovascular thrombectomy and rescue therapy for acute ischemic stroke with underlying ICAD,(5) endovascular interventional therapy for postacute symptomatic intracranial arterial stenosis, and (6) surgical treatment of chronic symptomatic intracranial arterial stenosis. Intensive medical treatment including antiplatelet therapy, risk factor control, and life style modification are essential for patients with ICAD. Keywords: Anticoagulants; Antiplatelets; Intracranial atherosclerotic disease; Stenting; Stroke; Thrombectomy 1. INTRODUCTION Intracranial atherosclerotic disease (ICAD) is a major cause for ischemic stroke in Asia. However, not until recently did the guidelines for stroke management focus on ICAD. In the current review, we proposed the guidelines for diagnosis and treatment of ICAD according to the updated evidence. The guidelines are divided into six chapters as follows. 1. Epidemiology and diagnostic evaluation of ICAD. 2. Nonpharmacological management of ICAD. 3. Medical therapy for symptomatic ICAD. 4. Endovascular thrombectomy and rescue therapy for acute ischemic stroke with underlying ICAD. * Address correspondence. Dr. I-Hui Lee, Department of Neurology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: [ihui_lee@hotmail.com](ihui_lee@hotmail.com) (I.-H. Lee). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 697-714. Received March 3, 2023; accepted May 18, 2023. doi: 10. 1097/JCMA.0000000000000952. Copyright © 2023, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/))

FAQs

What is intracranial atherosclerotic disease (ICAD) and why are these guidelines needed?

ICAD is a major cause of ischemic stroke, especially in Asian populations, and is associated with high recurrent stroke risk and cardiovascular comorbidities. The guidelines aim to provide updated, evidence-based recommendations for diagnosis and management.

How were the recommendations developed in the Taiwan Stroke Society guidelines?

The Taiwan Stroke Society guideline consensus group developed recommendations through consensus meetings based on updated evidence. Each proposed recommendation’s class and level of evidence were approved by all group members.

What treatment areas do the guidelines cover for patients with ICAD?

The guidelines cover six topics: epidemiology and diagnostic evaluation, nonpharmacological management, medical therapy for symptomatic ICAD, endovascular thrombectomy and rescue therapy for acute ischemic stroke with underlying ICAD, endovascular interventional therapy for postacute symptomatic intracranial stenosis, and surgical treatment for chronic symptomatic intracranial arterial stenosis.

Sep 29, 2026

Upload by Sarah