Endothelial Cell Genetics in Carotid Artery Atherosclerosis and Intracranial Atherosclerosis: A Systematic Review

Ischemic stroke, a leading cause of global mortality, is often linked to large‐artery atherosclerosis, including carotid artery atherosclerotic disease and intracranial atherosclerotic disease. Endothelial cells, which are central to vascular homeostasis, are pivotal in the pathophysiology of these conditions. This systematic review explores the genetic and molecular characteristics of endothelial cells in carotid artery atherosclerotic disease and intracranial atherosclerotic disease, emphasizing their roles in disease progression and potential therapeutic applications. The findings reveal significant differences in the underlying mechanisms of carotid artery atherosclerotic disease and intracranial atherosclerotic disease, reflecting the unique genetic, inflammatory, and vascular remodeling processes associated with each condition. Endovascular biopsy is examined as a minimally invasive method for isolating endothelial cells, providing a valuable tool for studying disease‐specific pathways and advancing precision medicine, although improvements in technique and consistency are still required. This review underscores the importance of integrating advanced genetic and transcriptomic analyses with refined biopsy methods to better understand the molecular drivers of cerebrovascular atherosclerosis. These advancements are critical for identifying novel therapeutic targets, improving diagnostic accuracy, and ultimately enhancing patient outcomes.