A Pathological Perspective on the Natural History of Cerebral Atherosclerosis. Issue 7 (October 2015)

• Record Type: Journal Article
• Authors: Gutierrez, Jose; Elkind, Mitchell S. V.; Virmani, Renu; Goldman, James; Honig, Lawrence; Morgello, Susan; Marshall, Randolph S.
• Is Part Of: International journal of stroke. Volume 10:Issue 7(2015:Oct.)
• Page Start: 1074
• Page End: 1080
• Publication Date: 2015-10
• Subjects: cerebral atherosclerosis -- noncardioembolic stroke -- stenosis; 616.8005
• DOI: 10.1111/ijs.12496
• Languages: English
• ISSNs: 1747-4930

Abstract

Background: The natural history of intracranial large artery atherosclerosis has been mainly described from lumen-based imaging studies, and much of what is reported to be known about atherosclerosis is derived from non-cerebral arteries. Aims: To test the hypothesis that atherosclerosis is only partially represented by stenosis and that advanced atherosclerosis is more common that severe stenosis in noncardioembolic infarcts. Methods: Cerebral large arteries from 196 autopsy cases were studied. The revised American Heart Association classification for atherosclerosis was used to determine the phenotype in each available artery. Cross-sectional lumen stenosis was obtained as defined by the Glagov's method. Results: As age of cases increased, there was a progressive increment in the frequency of atherosclerotic lesions, rising from 5% of all arteries at age 20–40, to more than 40% at age 60 or older. Stenosis also increased with age: less than 3% of the arteries in those ≤50 years had >40% stenosis, while one out of five arteries in those >80 years had >40% stenosis. In most cases (80%), atherosclerosis and stenosis were directly related. However, one out of five cases with advanced atherosclerosis had <30% stenosis. In arteries supplying brain areas with noncardioembolic infarcts, the majority of segments exhibiting advanced atherosclerosis had lumen stenosis of <40%. Conclusion: Although intracranial atherosclerosis is typically associated with stenosis, a substantial minority of cases shows advanced atherosclerosis in the absence of stenosis >40%. Definitions based solely on stenosis may underestimate the extent and role of intracranial large artery atherosclerosis.