Unraveling Cerebral Stenosis: Current Insights Into Diagnosis and Neurointervention Management

Baiq Hilya Kholida; I Gusti Lanang Krisna Wiracakra; Endah Irnanda Ulfah Gea

doi:10.29303/jbt.v25i4.10074

Unraveling Cerebral Stenosis: Current Insights Into Diagnosis and Neurointervention Management

Authors

Baiq Hilya Kholida , I Gusti Lanang Krisna Wiracakra , Endah Irnanda Ulfah Gea

DOI:

10.29303/jbt.v25i4.10074

Published:

2025-10-18

Issue:

Vol. 25 No. 4 (2025): in Progress

Keywords:

EDAS, Intracranial stenosis, Ischemic stroke, Neurointervention

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Kholida, B. H., Wiracakra, I. G. L. K., & Gea, E. I. U. (2025). Unraveling Cerebral Stenosis: Current Insights Into Diagnosis and Neurointervention Management. Jurnal Biologi Tropis, 25(4), 5795–5803. https://doi.org/10.29303/jbt.v25i4.10074

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Abstract

Intracranial atherosclerotic stenosis (ICAS) represents a major cause of ischemic stroke worldwide, particularly among Asian, African, and Hispanic populations. Atherosclerosis is the primary underlying pathology, and severe symptomatic stenosis (70–99%) is associated with up to a 25% risk of recurrent stroke within two years. Accurate diagnosis and optimal management are critical to improving outcomes and preventing recurrence. A comprehensive literature review was conducted using Google Scholar, PubMed, and ScienceDirect databases for studies published between 2012 and 2025. Relevant articles addressing the etiology, pathophysiology, diagnostic imaging, and therapeutic approaches to ICAS were analyzed and synthesized. ICAS is strongly associated with modifiable risk factors; hypertension, diabetes mellitus, dyslipidemia, and smoking as well as non-modifiable factors such as age, sex, and ethnicity. Diagnostic confirmation relies on neuroimaging modalities including CTA, MRA, and digital subtraction angiography (DSA), with DSA remaining the gold standard. Aggressive best medical therapy (BMT), consisting of dual antiplatelet therapy, statins, risk-factor control, and lifestyle modification, significantly reduces stroke recurrence. Endovascular revascularization and surgical procedures such as encephaloduroarteriosynangiosis (EDAS) may be considered for selected high-grade or refractory cases. ICAS remains a leading cause of recurrent ischemic stroke. Early detection through advanced imaging and comprehensive, individualized managementprimarily with medical therapy, supplemented by endovascular or surgical intervention when indicated offers the best outcomes for affected patients.

References

Barnard, Z.R., Alexander, M.J., 2020. Update in the treatment of intracranial atherosclerotic disease. Stroke Vasc Neurol 5, 59–64. https://doi.org/10.1136/svn-2019-000279

Bentzon, J.F., Otsuka, F., Virmani, R., Falk, E., 2014. Mechanisms of plaque formation and rupture. Circ Res 114, 1852–1866. https://doi.org/10.1161/CIRCRESAHA.114.302721

Chen, K.H., Lin, C.Y., Su, S. Bin, Chen, K.T., 2022. Leprosy: A Review of Epidemiology, Clinical Diagnosis, and Management. J Trop Med 2022. https://doi.org/10.1155/2022/8652062

Chen, L.H., Spagnolo-Allende, A., Yang, D., Qiao, Y., Gutierrez, J., 2024. Epidemiology, Pathophysiology, and Imaging of Atherosclerotic Intracranial Disease. Stroke. https://doi.org/10.1161/STROKEAHA.123.043630

Dunn, L.E., Wang, Y., Kass-Hout, T., Chiu, D., 2024. Randomized Secondary Prevention Trials in Participants with Symptomatic Intracranial Atherosclerotic Stenosis. Stroke. https://doi.org/10.1161/STROKEAHA.123.043632

Elder, T.A., White, T.G., Woo, H.H., Siddiqui, A.H., Nunna, R., Siddiq, F., Esposito, G., Chang, D., Gonzalez, N.R., Amin-Hanjani, S., 2024. Future of Endovascular and Surgical Treatments of Atherosclerotic Intracranial Stenosis. Stroke 55, 344–354. https://doi.org/10.1161/STROKEAHA.123.043634

Flusty, B., De Havenon, A., Prabhakaran, S., Liebeskind, D.S., Yaghi, S., 2020. Intracranial Atherosclerosis Treatment: Past, Present, and Future. Stroke 51, E49–E53. https://doi.org/10.1161/STROKEAHA.119.028528

Gonzalez, N.R., Dusick, J.R., Connolly, M., Bounni, F., Martin, N.A., Van De Wiele, B., Liebeskind, D.S., Saver, J.L., 2015. Encephaloduroarteriosynangiosis for adult intracranial arterial steno-occlusive disease: Long-term single-center experience with 107 operations. J Neurosurg 123, 654–661. https://doi.org/10.3171/2014.10.JNS141426

Kim, J.S., Bonovich, D., 2014. Research on Intracranial Atherosclerosis from the East and West: Why Are the Results Different? J Stroke 16, 105. https://doi.org/10.5853/jos.2014.16.3.105

Kleindorfer, D.O., Towfighi, A., Chaturvedi, S., Cockroft, K.M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W.N., Kittner, S.J., Leira, E.C., Lennon, O., Meschia, J.F., Nguyen, T.N., Pollak, P.M., Santangeli, P., Sharrief, A.Z., Smith, S.C., Turan, T.N., Williams, L.S., 2021. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association, Stroke. https://doi.org/10.1161/STR.0000000000000375

Li, J., Pan, Y., Wang, M., Meng, X., Lin, J., Li, Z., Li, H., Wang, Yilong, Zhao, X., Liu, L., Wang, Yongjun, 2024. High-Sensitivity C-reactive Protein and Intracranial Arterial Stenosis Predicted Recurrent Stroke and Dependence or Death in Minor Stroke or Transient Ischemic Attack. J Atheroscler Thromb 31, 249–258. https://doi.org/10.5551/jat.64229

Liu, R., Shao, J., 2022. Research progress on risk factors related to intracranial artery, carotid artery, and coronary artery stenosis. Front Cardiovasc Med 9. https://doi.org/10.3389/fcvm.2022.970476

Lucaareglii·, G., Yasuhikookakuu· Michihirootanakaa, M., n.d. Acta Neurochirurgica Supplement 132.

Luo, J., Wang, T., Yang, K., Wang, X., Xu, R., Gong, H., Zhang, X., Wang, J., Yang, R., Gao, P., Ma, Y., Jiao, L., 2023. Endovascular therapy versus medical treatment for symptomatic intracranial artery stenosis. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD013267.pub3

Panagiotopoulos, E., Stefanou, M.I., Magoufis, G., Safouris, A., Kargiotis, O., Psychogios, K., Vassilopoulou, S., Theodorou, A., Chondrogianni, M., Bakola, E., Frantzeskaki, F., Sidiropoulou, T., Spiliopoulos, S., Tsivgoulis, G., 2024. Prevalence, diagnosis and management of intracranial atherosclerosis in White populations: a narrative review. Neurol Res Pract 6. https://doi.org/10.1186/s42466-024-00341-4

Petrone, L., Nannoni, S., Del Bene, A., Palumbo, V., Inzitari, D., 2016. Branch atheromatous disease: A clinically meaningful, yet unproven concept. Cerebrovascular Diseases 41, 87–95. https://doi.org/10.1159/000442577

Prabhakaran, S., Liebeskind, D.S., Cotsonis, G., Nizam, A., Feldmann, E., Sangha, R.S., Campo-Bustillo, I., Romano, J.G., 2022. Lipid Levels and Short-Term Risk of Recurrent Brain Infarcts in Symptomatic Intracranial Stenosis. Journal of Stroke and Cerebrovascular Diseases 31, 1–11. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106141

Psychogios, M., Brehm, A., López-Cancio, E., Marco De Marchis, G., Meseguer, E., Katsanos, A.H., Kremer, C., Sporns, P., Zedde, M., Kobayashi, A., Caroff, J., Bos, D., Lémeret, S., Lal, A., Arenillas, J.F., 2022. European Stroke Organisation guidelines on treatment of patients with intracranial atherosclerotic disease. Eur Stroke J 7, III–IV. https://doi.org/10.1177/23969873221099715

Ryu, J.C., Bae, J.H., Ha, S.H., Kwon, B., Song, Y., Lee, D.H., Kim, B.J., Kang, D.W., Kwon, S.U., Kim, J.S., Chang, J.Y., 2023. Association between lipid profile changes and risk of in-stent restenosis in ischemic stroke patients with intracranial stenosis: A retrospective cohort study. PLoS One 18, 1–11. https://doi.org/10.1371/journal.pone.0284749

Sanchez, S., Mossa-Basha, M., Anagnostakou, V., Liebeskind, D.S., Samaniego, E.A., 2024. Comprehensive imaging analysis of intracranial atherosclerosis. J Neurointerv Surg 1–12. https://doi.org/10.1136/jnis-2023-020622

Stapleton, C.J., Chen, Y.F., Shallwani, H., Vakharia, K., Turan, T.N., Woo, H.H., Derdeyn, C.P., Charbel, F.T., Siddiqui, A.H., Amin-Hanjani, S., 2020. Submaximal Angioplasty for Symptomatic Intracranial Atherosclerotic Disease: A Meta-Analysis of Peri-Procedural and Long-Term Risk. Neurosurgery 86, 755–762. https://doi.org/10.1093/neuros/nyz337

Tai, M.-L.S., Khoo, J.K., Elwaifa, A., 2018. Extracranial Carotid Atherosclerosis in the Patients with Transient Ischemic Attack. intechopen.

Turan, T.N., Makki, A.A., Tsappidi, S., Cotsonis, G., Lynn, M.J., Cloft, H.J., Chimowitz, M.I., 2010. Risk factors associated with severity and location of intracranial arterial stenosis. Stroke 41, 1636–1640. https://doi.org/10.1161/STROKEAHA.110.584672

Verheggen, I.C.M., de Jong, J.J.A., van Boxtel, M.P.J., Postma, A.A., Jansen, J.F.A., Verhey, F.R.J., Backes, W.H., 2020. Imaging the role of blood–brain barrier disruption in normal cognitive ageing. Geroscience 42, 1751–1764. https://doi.org/10.1007/s11357-020-00282-1

Wabnitz, A.M., Turan, T.N., 2024a. Optimal Medical Management of Atherosclerotic Intracranial Stenosis. Stroke. https://doi.org/10.1161/STROKEAHA.123.043633

Wabnitz, A.M., Turan, T.N., 2024b. Optimal Medical Management of Atherosclerotic Intracranial Stenosis. Stroke 55, 335–343. https://doi.org/10.1161/STROKEAHA.123.043633

Wang, Y., Fan, Hongxuan, Duan, W., Ren, Z., Liu, X., Liu, T., Li, Y., Zhang, K., Fan, Haimei, Ren, J., Li, J., Li, X., Wu, X., Niu, X., 2023. Elevated stress hyperglycemia and the presence of intracranial artery stenosis increase the risk of recurrent stroke. Front Endocrinol (Lausanne) 13, 1–15. https://doi.org/10.3389/fendo.2022.954916

Xu, W.-H., Li, M.-L., Gao, S., Ni, J., Zhou, L.-X., Yao, M., Peng, B., Feng, F., Jin, Z.-Y., Cui, L.-Y., 2011. Plaque Distribution of Stenotic Middle Cerebral Artery and Its Clinical Relevance. https://doi.org/10.1161/STROKEAHA.111.618132/-/DC1

Xu, Y.Y., Li, M.L., Gao, S., Jin, Z.Y., Sun, Z.Y., Chen, J., Hou, B., Zhou, H.L., Feng, F., Xu, W.H., 2017. Etiology of intracranial stenosis in young patients: A high-resolution magnetic resonance imaging study. Ann Transl Med 5. https://doi.org/10.21037/atm.2017.06.31

Yao, T., Di, A., Li, J., Zhang, S., He, J., Xu, N., Xu, D., 2022. Association Between Serum Uric Acid and Intracranial Arterial Stenosis in a Korean Population: A Secondary Analysis Based on a Cross-Sectional Study. Front Neurol 13. https://doi.org/10.3389/fneur.2022.791456

Zhang, X., Wu, D., Li, H., Fang, Y., Xiong, H., Li, Y., 2022. Early Diagnosis of Intracranial Internal Carotid Artery Stenosis Using Extracranial Hemodynamic Indices from Carotid Doppler Ultrasound. Bioengineering 9. https://doi.org/10.3390/bioengineering9090422

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Unraveling Cerebral Stenosis: Current Insights Into Diagnosis and Neurointervention Management

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