Intracranial Atherosclerotic Disease: A Narrative Review of Its Role in Ischemic Stroke and Advances in Endovascular Therapy

Document Type : Review Article

Authors

1 Neurology department, Faculty of Medicine, Sohag University, Sohag, Egypt

2 Neurology department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Abstract

Intracranial Atherosclerotic Disease (ICAD) is a significant global health challenge, causing ischemic stroke. The disease is prevalent in Asian, Hispanic, and African populations, with a higher prevalence observed. The mechanisms leading to stroke are complex, including artery-to-artery embolism, perforator occlusion, and impaired distal perfusion due to hemodynamic insufficiency. Aggressive medical management (AMM) is the cornerstone and first-line treatment for ICAD, demonstrating considerable effectiveness in mitigating stroke recurrence. However, landmark randomized controlled trials like SAMMPRIS, VISSIT, and CASSISS have generally not demonstrated the superiority of endovascular interventions over AMM as a primary treatment strategy due to associated periprocedural risks. Despite these challenges, endovascular therapies maintain a critical role, particularly in the acute management of large vessel occlusion (LVO) and for carefully selected patient cohorts who remain symptomatic despite optimal medical therapy. The field is poised for transformative advancements, including the development and refinement of novel devices, and a pivotal shift towards personalized medicine approaches. These ongoing efforts and the design of next-generation clinical trials are vital to address specific high-risk subgroups and refine treatment protocols, ultimately aiming to improve long-term outcomes for individuals affected by ICAD.

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Sohag Medical Journal
Volume 29, Issue 3
Clinical Science Volume
2025
Pages 64-78

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