Intracranial Atherosclerotic Disease: Treatment Potential and Diagnostic Opportunities
- 1 Laboratory of Angiopathology, Institute for Atherosclerosis Research, Russia
- 2 Laboratory of Angiopathology, Institute of General Pathology and Pathophysiology, Russia
- 3 Insitute of Human Morphology, Petrovsky Russian National Center of Surgery, 2 Abrikosovsky Lane, 119991 Moscow, Russia
- 4 Vascular Surgery Department, A. V. Vishnevsky National Medical Research Center of Surgery, 27 Bolshaya Serpukhovskaya Street, 117997 Moscow, Russia
Abstract
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.
DOI: https://doi.org/10.3844/ojbsci.2026.26.01.002
Copyright: © 2026 Anastasia Vladimirovna Poznyak, Victoria Alexandrovna Khotina, Anton Yuvenalievich Postnov, Vasily Nikolaevich Sukhorukov, Arthur Anatolievich Lee, Alexander Leonidovich Golovyuk and Alexander Nikolaevich Orekhov. This is an open access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Keywords
- Intracranial atherosclerosis
- Intracranial atherosclerotic disease
- ICAD
- Ischemic stroke
- Atherosclerotic plaque
- Lipid metabolism
- LDL
- Inflammation
- Immune response
- Genetic risk factors
- Transcranial Doppler
- TCD
- CT Angiography
- CTA
- Magnetic Resonance Angiography
- MRA
- Digital Subtraction Angiography
- DSA
- Antithrombotic therapy
- Lipid-lowering therapy
- Stenting
- Endarterectomy
- Ischemic conditioning
- Anti-inflammatory therapy
- Risk factor modification
- Cerebrovascular disease
- Stroke prevention