title: Current diagnosis and management of symptomatic intracranial atherosclerotic disease.
abstract: OBJECTIVE
  Intracranial atherosclerotic disease (IAD) is likely the most common cause of stroke world-wide and is associated with a very high risk of recurrence. It results in cerebral ischemia due to a variety of mechanisms, including artery-to-artery embolism, hemodynamic failure, and occlusion of penetrating arteries. New imaging modalities focused on physiological consequences of IAD have become available and recent treatment trials have been completed.
  
  
  RESULTS
  We review the traditional imaging modalities, emphasizing the advantages and limitations of each method, and discuss the novel physiological approaches that interrogate physiological process to indicate specific mechanisms of ischemia. These allow deeper understanding of the pathophysiological processes that underlie IAD-related ischemia. The key findings of recent therapeutic trials are reviewed, including the landmark randomized studies showing advantage of antiplatelet agents and risk factor modification, and a significant risk of complications with endovascular approaches.
  
  
  CONCLUSIONS
  Current evidence argues for aggressive medical management and suggests caution with interventional treatments. We propose that mechanistic information will further refine the risk assessment of patients with IAD to offer targeted therapy.
authors.affiliation: Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
authors.forename: Jose G
authors.initials: JG
authors.lastname: Romano
mesh_terms: D002545:Brain Ischemia / Q000209:etiology; D002560:Cerebrovascular Circulation; D003251:Constriction, Pathologic / Q000150:complications / Q000473:pathology; D019468:Disease Management; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D059906:Neuroimaging / Q000379:methods; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D015912:Thrombolytic Therapy