Atherosclerosis in the circle of Willis: Spatial differences in composition and in distribution of plaques

Denswil, Nerissa P.; Wal, Allard C. van der; Ritz, Katja; Boer, Onno J. de; Aronica, Eleonora; Troost, Dirk; Daemen, Mat J.A.P.

doi:10.1016/j.atherosclerosis.2016.05.047

Cited by 37 publications

(36 citation statements)

References 41 publications

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“…In our subgroup analyses, the proximal vessel segments showed the largest incremental increase in the detection of abnormal segments. As intracranial atherosclerosis has a predilection for proximal intracranial arteries, our results suggest that abnormal but prestenotic lesions may not be detected accurately, which may underestimate disease prevalence.…”

Section: Discussionmentioning

confidence: 81%

Vessel Wall MRI Added to MR Angiography in the Evaluation of Suspected Vasculopathies

Song

Obusez

Raymond

et al. 2019

Journal of Neuroimaging

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METHODS: Ninety-three consecutive subjects with a clinical history of suspected vasculopathy imaged with both VWI and 3D-TOF-MRAs were retrospectively reviewed. The 3D-TOF-MRAs were reviewed by two independent neuroradiologists classifying arterial segments as normal or abnormal based on caliber changes. Following a 2-week wash-out period, the 3D-TOF-MRAs with VWI together were re-evaluated for caliber changes and/or vessel wall enhancement. A third neuroradiologist served as consensus. Significance was assessed by McNemar's test. RESULTS:Forty-two subjects with VWI and 3D-TOF-MRAs met the inclusion criteria. By 3D-TOF-MRA alone, 12.3% (95% confidence interval [CI], 10.7-15.1) of the arterial segments were identified as abnormal compared to 20.8% (95% CI, 18.2-23.4) by VWI and 3D-TOF-MRA together (P < .0001). CONCLUSIONS: 3D-TOF-MRA and VWI together identifies a higher number of abnormal vessel segments than 3D-TOF-MRA alone and may provide a more accurate assessment of disease burden.

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Section: Discussionmentioning

confidence: 81%

Vessel Wall MRI Added to MR Angiography in the Evaluation of Suspected Vasculopathies

Song

Obusez

Raymond

et al. 2019

Journal of Neuroimaging

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“…The more advanced atherosclerotic changes were infrequently detected in intracranial artery until the very old years [ 16 , 51 ], such as calcified lesion first detected in the 6th decade, and ulcerated lesion first observed in the 9th decade [ 8 ]. A study of 1,220 segments of circle of Willis from 67 randomly chosen autopsy cases showed that early plaques were predominant (66%) and advanced plaques exceptional (15%), whereas complicated plaques were present in only 1% of lesions [ 52 ]. Figure 3 shows the plaque components on histology.…”

Section: Histopathological Evidence From Human Cadaversmentioning

confidence: 99%

“…In carotid artery involved with atherosclerosis, intraplaque hemorrhage was observed in as high as 19% to 97% within symptomatic lesions and 7% to 91% within asymptomatic lesions [ 53 , 54 ]. By contrast, a much lower prevalence of intraplaque hemorrhage was reported in studies involving intracranial arteries: only one lesion with intraplaque hemorrhage was reported in 205 intracranial arterial segments [ 55 ] and 6 of 1,220 segments had intraplaque hemorrhage among patients who had cardiovascular-related events [ 52 ]. But the samples of these two studies were taken at specific locations per circle of Willis specimen, which may lead to an underestimate of the prevalence of intraplaque hemorrhage.…”

Section: Histopathological Evidence From Human Cadaversmentioning

confidence: 99%

“…Our most recent retrospective study illustrated the correlation of high extent of internal carotid artery calcification with downstream microembolic signal detected by transcranial Doppler, suggesting that severe cerebral artery calcification might indicate complex or unstable atherosclerotic lesions [ 60 ]. On histology, an autopsy study among Caucasians detected only 3% of intracranial arteries containing calcification, mostly detected in the VA, which was much less frequent than that in coronary and carotid arteries [ 52 ]. Comparatively, we reported a high prevalence of calcification within cerebral arteries specimens from a series of Chinese adult autopsy cases: 35% (16/46) calcification within symptomatic MCA plaques and 23% (15/65) within asymptomatic MCA plaques [ 56 ].…”

Section: Histopathological Evidence From Human Cadaversmentioning

confidence: 99%

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Intracranial Atherosclerosis: From Microscopy to High-Resolution Magnetic Resonance Imaging

2017

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Intracranial atherosclerosis is one of the leading causes of ischemic stroke and occurs more commonly in patients of Asian, African or Hispanic origin than in Caucasians. Although the histopathology of intracranial atherosclerotic disease resembles extracranial atherosclerosis, there are some notable differences in the onset and severity of atherosclerosis. Current understanding of intracranial atherosclerotic disease has been advanced by the high-resolution magnetic resonance imaging (HRMRI), a novel emerging imaging technique that can directly visualize the vessel wall pathology. However, the pathological validation of HRMRI signal characteristics remains a key step to depict the plaque components and vulnerability in intracranial atherosclerotic lesions. The purpose of this review is to describe the histological features of intracranial atherosclerosis and to state current evidences regarding the validation of MR vessel wall imaging with histopathology.

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“…The prevalence of calcifications in the arteries in our sample is higher than reported in other cohorts with systemic analysis of the circle of Willis (5.4% versus 3% of all arteries assessed). 19 This discrepancy may relate to the difference in vascular risk factors and slightly higher proportion of men in our study. Additionally, we did not decalcified our specimen before fixation and embedding, which may have facilitate identification of calcium deposits in our sample.…”

Section: Discussionmentioning

confidence: 58%

Pathological correlates of brain arterial calcifications

Shapiro

Goldman

Morgello

et al. 2019

Cardiovascular Pathology

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Background: In clinical practice, calcifications seen on CT studies within the large brain arteries are often referred as a surrogate marker for cholesterol-mediated atherosclerosis. However, limited data exists to support the association between calcification and atherosclerosis. In this study, we examined if intracranial arterial calcifications were associated with cholesterol-mediated intracranial large artery atherosclerosis (ILAA) within the arteries of the Circle of Willis in an autopsy based sample. Methods: We carried out a cross-sectional analysis of histopathological characteristics of brain large arteries obtained from autopsy cases. Brain large arteries were examined for evidences of calcifications, which were rated as macroscopic (coalescent) and microscopic (scattered). In addition to calcification, we also obtained measurement of the arterial wall and the presence of ILAA and non-atherosclerotic arterial fibrosis. We built hierarchical models adjusted for demographic and vascular risk factors to assess the relationship between calcification and ILAA. Results: In univariate analysis, the presence of any arterial calcifications was associated with cerebral infarcts (29% v. 14%, p<0.01). Multi-variate analysis revealed that among all calcifications, coalescent calcifications were not associated with ILAA. In contrast, scattered calcifications were associated with ILAA (p<0.001), decreased lumen diameter (−1.87 +/− 0.41 mm p≤0.001) and increased luminal stenosis (0.03 +/− 0.01% p≤0.006). These findings were independent of age, sex or other vascular risk factors. Conclusions: This study demonstrates that coalescent calcifications in brain large arteries, although associated with morbidity, are not synonymous with cholesterol driven ILAA. Understanding the precise pathological components of cerebrovascular disease, including non-atherosclerotic arterial calcifications, will help develop individualized therapies beyond amelioration of traditional risk factors such as hyperlipidemia.

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Atherosclerosis in the circle of Willis: Spatial differences in composition and in distribution of plaques

Abstract: Advanced atherosclerotic plaques in the CoW are relatively scarce and mainly located in the 4 large arteries, and mostly characterized by an early and stable phenotype, a low calcific burden, and a low frequency of IPH.

Cited by 37 publications

References 41 publications

Vessel Wall MRI Added to MR Angiography in the Evaluation of Suspected Vasculopathies

Vessel Wall MRI Added to MR Angiography in the Evaluation of Suspected Vasculopathies

Intracranial Atherosclerosis: From Microscopy to High-Resolution Magnetic Resonance Imaging

Pathological correlates of brain arterial calcifications

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