World Journal of Cardiovascular Diseases, 2014, 4, 350-360 Published Online June 2014 in SciRes. http://www.scirp.org/journal/wjcd http://dx.doi.org/10.4236/wjcd.2014.47044 How to cite this paper: Mansour, O., Schumacher, M., Farrag, M.A. and Abd-Allah, F. (2014) Intracranial Atherosclerosis: The Natural History and Management Strategies. World Journal of Cardiovascular Diseases, 4, 350-360. http://dx.doi.org/10.4236/wjcd.2014.47044 Intracranial Atherosclerosis: The Natural History and Management Strategies Ossama Mansour 1,2 , Martin Schumacher 2 , Mohammad A. Farrag 3 , Foad Abd-Allah 3* 1 Neurology and Interventional Neurology Service Department, Alexandria University Hospital, Alexandria, Egypt 2 Freiburg Uniklinik, Neurozentrium, Neuroradiologie Abt., Freiburg, Germany 3 Neurology Department, Cairo University Hospitals, Cairo, Egypt Email: * foad.abdallah@kasralainy.edu.eg . Received 20 April 2014; revised 23 May 2014; accepted 31 May 2014 Copyright © 2014 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Abstract Intracranial atherosclerotic disease (ICAD) represents a major cause of stroke and transient is- chemic attacks. The prevalence and natural course of ICAD are closely related to race and ethnicity. The best treatment for ICAD is a crucial issue; data from recent trials indicate that aggressive medical management and life style modifications are better than endovascular treatments for prevention of recurrent stroke in high-risk patients with ICAD. Endovascular treatment is still an option for subgroup of patients who are not responded to optimal medical therapy. Keywords Intracranial Atherosclerosis, Medical Therapy, Endovascular Treatment 1. Introduction Stroke is one of the global leading causes of death and disability as confirmed by many epidemiological studies [1]. Intracranial cerebral atherosclerosis accounts for approximately 8% - 10% of all ischemic strokes with a higher reported incidence in the Asian, African, and Hispanic descent populations [2]. Ethnicity accounts for significant variation in the incidence of the disease in symptomatic patients, but the effect of ethnicity in as- ymptomatic patients is not clear [3]. The risk factors for the development of intracranial atherosclerotic disease are broadly classified as non-modifi- able (e.g. age, gender); modifiable―which are well documented―(e.g. hypertension, total serum cholesterol); and potentially modifiable factors―which are less well documented―(e.g. diabetes mellitus, metabolic syndrome) [4]. * Corresponding author.