Intracranial Atherosclerotic Disease Management

Intracranial atherosclerotic disease arises from the progressive accumulation of lipid-laden plaques within the major arteries of the brain, leading to vessel narrowing, reduced cerebral perfusion and an elevated risk of ischaemic stroke. Management strategies span from optimal medical therapy—comprising antiplatelet agents, lipid-lowering drugs, stringent blood pressure control and lifestyle modification—to endovascular interventions such as balloon angioplasty and stent placement. Recent advances have refined patient selection criteria, procedural techniques and device design to mitigate periprocedural complications and improve long-term vessel patency. The current standard of care emphasises intensive medical management as first-line treatment for most patients, reserving endovascular approaches for those with recurrent events despite optimal therapy or with high-grade stenoses in critical vascular territories. Multidisciplinary teams, incorporating neurologists, neuroradiologists and interventional specialists, now collaborate to individualise the balance between pharmacological risk reduction and procedural benefit. Emerging imaging modalities and computational modelling further assist in assessing plaque haemodynamics and guiding therapeutic choice, reinforcing a tailored strategy that addresses both global cerebrovascular risk and lesion-specific factors.

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Intracranial Atherosclerotic Disease Management publication trend

The graph below shows the total number of articles in intracranial atherosclerotic disease management across all publications each year (not limited to Nature Index journals).

Technical terms

Symptomatic intracranial stenosis: Narrowing of a cerebral artery by ≥50% that has caused transient ischaemic attack or stroke symptoms.

Intensive medical management: Combination of antiplatelet therapy, lipid-lowering agents, blood pressure control and lifestyle interventions.

Balloon angioplasty: Endovascular dilation of a stenotic artery via an inflatable catheter to restore vessel diameter.

Stent: A small mesh scaffold deployed within an artery to maintain luminal patency after angioplasty.

Periprocedural complication: Adverse event such as stroke or haemorrhage occurring during or within 30 days of an intervention.

Restenosis: Re-narrowing of a treated vessel segment, typically defined as ≥50% loss of luminal diameter after intervention.

References

1. Prevalence, predictors, and prognosis of symptomatic intracranial stenosis in patients with transient ischaemic attack or minor stroke: a population-based cohort study. The Lancet Neurology (2020).
2. Multicenter Prospective Trial of Stent Placement in Patients with Symptomatic High-Grade Intracranial Stenosis. American Journal of Neuroradiology (2016).
3. Prognosis of Asymptomatic Intracranial Stenosis in Patients With Transient Ischemic Attack and Minor Stroke. JAMA Neurology (2020).