[Detection and Management of Asymptomatic Cerebrovascular Disease].

Asymptomatic carotid or intracranial arterial stenosis, silent brain infarction, cerebral white matter lesions, and cerebral microbleeds are well-established predictors of stroke. When these findings are detected through brain screening programs ("brain dock"), aggressive management of vascular risk factors is warranted. In cases of severe carotid stenosis, revascularization procedures such as carotid endarterectomy or carotid artery stenting may be considered. In East Asia, including Japan, genetic predisposition appears to play a significant role. The moyamoya disease-related RNF213 p.R4810K variant has been linked to intracranial arterial stenosis, and NOTCH3 variants are associated with an increased burden of white matter disease. Closer integration of screening programs and routine clinical care is expected to further enhance the value of brain dock.