A Decade On: The Evolving Renaissance in Intracranial Atherosclerotic Disease

Intracranial atherosclerotic disease is the most common cause of stroke worldwide. The past decade of research in intracranial atherosclerotic disease has led to marginally improved medical therapy, yet recurrent stroke rates remain high. Despite the enormous global burden of disease, we lack effective clinical acumen to appropriately risk stratify patients and optimize the therapeutic approach. In this review, we examine our current understanding of intracranial atherosclerotic disease pathophysiology, imaging techniques, lifestyle, medical therapy, and endovascular strategies. We also present steps needed to incorporate imaging and serum biomarkers in intracranial atherosclerotic disease to facilitate individualized treatment plans and realize the potential of precision medicine in this global health disorder. Trials in the next decade should be targeted to help us gain a better understanding of key mechanisms and disease course with an ultimate goal of improving long-term patient outcomes.