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Intracranial atherosclerotic disease (ICAD) is an important cause of ischemic stroke and makes up for around 5-10% of all ischemic stroke cases. Hypertension, diabetic mellitus, metabolic syndrome, and increasing age are the main risk factors involved in development of ICAD. These patients have a 10-20% risk of developing each year, and this risk is even high in patients with high-grade stenosis.

The diagnosis of ICA is made with the help of imaging techniques like magnetic resonance angiography, computed tomographic angiography, digital subtraction angiopathy, and transcranial doppler. Earlier, the preferred management for patients with ICAD was with antiplatelet therapy (dual) with risk factor management. However, in recent years due to the improvement in endovascular techniques, angioplasty and stenting have become an equally viable option for managing these patients due to the reported high technical success rates, low periprocedural complications, and their wider availability. Due to the high-risk stroke recurrence in symptomatic patients with ICAD, effective secondary stroke management strategies should be implemented.