Intracranial Atherosclerotic Disease: Treatment Potential and Diagnostic Opportunities

Atherosclerosis, characterized by the accumulation of atherosclerotic plaques within large arteries, substantially increases the risk of cardiovascular events, including ischemic stroke. Intracranial atherosclerotic disease (ICAD) represents a particularly significant clinical threat given its strong association with ischemic stroke across multiple intracranial arterial territories. This review provides a comprehensive analysis of the pathogenesis, diagnosis, and management of intracranial atherosclerosis. Special attention is given to the interplay of lipid metabolism disorders, chronic inflammation, immune responses, and genetic factors in disease progression. The review further highlights the diagnostic value of non-invasive imaging modalities, including Transcranial Doppler ultrasound (TCD), CT Angiography (CTA), Magnetic Resonance Angiography (MRA), and Digital Subtraction Angiography (DSA). Beyond established treatments such as antithrombotic therapy and lipid-lowering interventions, emerging therapeutic approaches, including ischemic conditioning and novel anti-inflammatory agents, are examined. The role of risk factor modification and surgical options such as stenting and endarterectomy are also discussed. By synthesizing current evidence and highlighting evolving strategies, this review aims to serve as a practical resource for clinicians involved in the diagnosis and treatment of ICAD, with the ultimate goal of improving patient outcomes and reducing stroke-related morbidity and mortality.