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Published on: August 12, 2025

Natural history of intracranial atherosclerosis: a critical review

Ricardo J Komotar1, David A Wilson, J Mocco

  • 1Department of Neurological Surgery, Columbia University, New York, New York, USA. rjk2103@columbia.edu

Neurosurgery
|April 1, 2006
PubMed

Insights

Intracranial atherosclerosis, a major stroke cause, shows varied prognosis by vessel. Middle cerebral artery disease has lower mortality, and asymptomatic cases are more benign, guiding treatment decisions.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Cardiovascular Research

Background:

  • Intracranial atherosclerosis is a significant cause of stroke globally.
  • Medical management of intracranial atherosclerosis can fail, leading to high risks of cerebral infarction and death.
  • Understanding the natural history of intracranial atherosclerosis is crucial for effective patient management, especially with emerging endovascular treatments.

Purpose of the Study:

  • To provide a comprehensive review of the natural history of intracranial atherosclerosis, specifically analyzing outcomes based on affected intracranial vessels.
  • To address the lack of vessel-specific data in previous studies on intracranial atherosclerosis.
  • To guide clinical decision-making and therapeutic developments for patients with intracranial atherosclerosis.

Main Methods:

  • A critical review of existing literature on the medical management of intracranial atherosclerosis.
  • Segregation of findings based on specific intracranial vessels (e.g., middle cerebral artery).
  • Analysis of prognostic factors including asymptomatic disease, plaque progression, and microemboli detection.

Main Results:

  • Middle cerebral artery atherosclerosis is associated with a lower mortality rate compared to stenoses in other intracranial vessels.
  • Asymptomatic intracranial atherosclerosis generally follows a more benign clinical course.
  • Limited data suggest plaque progression and microemboli detected via transcranial Doppler may predict patient outcomes.

Conclusions:

  • Prognosis of intracranial atherosclerosis varies significantly depending on the affected vessel.
  • Vessel-specific analysis is essential for understanding the natural history and guiding treatment strategies.
  • Further research into prognostic markers like plaque progression and microemboli is warranted.

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