In this study we review the risk factors associated with the formation and
progression of an atheroma plaque, the mechanism involved in cerebral ischemia
secondary to intracranial atheromatosis and possible medical treatment in primary
and secondary prevention. DEVELOPMENT: Medical treatment of intracranial stenoses
(ICS) is aimed at stopping the progression of the atheroma plaque and at
preventing recurrences in the case of symptomatic stenoses. It is based on the
control of vascular risk factors, the use of statins and antithrombotic therapy
(antiplatelet or anticoagulation drugs). Although antiplatelet agents have not
proved to be beneficial in the primary prevention of stroke, they are recommended
in patients with ICS in order to lower the risk of heart attack associated with
this pathology. The use of antiplatelet drugs in the secondary prevention of
ischemic stroke secondary to an ICS is based on clinical trials which have shown
that antiaggregation prevents non-cardioembolic strokes. Nevertheless, several
retrospective studies have observed that oral anticoagulation is better than
antiaggregation with aspirin. Two prospective clinical trials are currently being
conducted which will, in the next few years, help to determine what the first
choice medical treatment is for this group of patients. CONCLUSIONS: Medical
treatment of ICS patients must include the control of vascular risk factors and
the use of statins. New studies are needed to be able to establish the first
choice antithrombotic drug in secondary prevention