Intracranial atherosclerotic stenosis (ICAS) is one of the major causes responsible for ischemic stroke in Asian, Africans, and Hispanics. Acute stroke due to ICAS can present side-branch or perforator infarction, artery-to-artery embolic, or in-situ large artery occlusion (LVO). Improvement in medical management has markedly decreased a recurrent ischemic stroke rate in ICAS patients after qualifying events. Nevertheless, the rate of recurrent ischemic stroke in ICAS is still quite high and preventive endovascular intervention (percutaneous transluminal angioplasty with or without stenting) may play a role in the selected patients who were refractory to medical management and anatomically feasible for preventive endovascular intervention. The most critical drawback of PTAS was a relatively high rate of treatment-related complications, resulting in higher rate of stroke than best medical treatment. To avoid treatment-related complications associated with PTAS and thereby improve treatment outcome, it is important to select right patients clinically appropriate and anatomically feasible for PTAS. Therefore, the first part of this research topic will be focused on the right patient selection, that is, who potentially benefit from angioplasty with or without stenting.

Nowadays, on the other hand, endovascular thrombectomy (EVT) is one of standard treatment for acute stroke due to large vessel occlusion (LVO). As mentioned above, although ICAS is one of the major causes of acute stroke in Asian, Africans, and Hispanics, there are a few reports on how much acute LVO is attributable to ICAS in-situ thromboocclusion. Furthermore, it is little studied on how to treat acute LVO due to ICAS: 1) is stent retriever safe and effective for ICAS LVO as for embolic LVO? 2) stent retriever or contact aspiration thrombectomy, of which is better for ICAS LVO? and 3) how to treat the ICAS LVO refractory to current EVT tools?

The second part of this Research Topic will address on acute LVO due to ICAS thromboocclusion.

Keywords: Intracranial atherosclerotic disease, acute stroke, large vessel occlusion, endovascular treatment

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