Intracranial Atherosclerotic Diseases (ICAD)

Intracranial atherosclerotic disease (ICAD) is a common etiology of stroke, accounting for up to 20% of all strokes worldwide. The risk of developing ICAD increases with age and risk factors including smoking, hypertension, and dyslipidemia. Stroke mechanisms secondary to ICAD vary and include hypoperfusion, artery-to-artery embolism, and plaque extension. Compared to other stroke mechanism, the risk of recurrent stroke among patients with ICAD is high, despite aggressive medical management. Further research evaluating novel therapies is necessary as surgical approaches including stenting have to date not shown benefit. This chapter aims to discuss the pathophysiology and epidemiology of ICAD. In addition, the efficacy of different management and treatment approaches is discussed based on recent clinical evidence.