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Intracranial atherosclerotic stenosis (ICAS) is a leading cause of ischaemic stroke globally, disproportionately affecting Asian populations. 1 Relative to other stroke aetiologies, ICAS is associated with more severe neurological deficits at presentation,2 substantial mortality3 4 and the highest risk of stroke recurrence despite optimal medical therapy.3 4 It has likewise been associated with dementia and cognitive decline, independent of overt cerebrovascular events.5 To date, ICAS remains a major contributor to stroke-related morbidity and continues to impose a significant burden on patients, caregivers and health systems.6