Autopsy Prevalence of Intracranial Atherosclerosis in Patients With Fatal Stroke

Abstract

Background and Purpose-The objective of this study was to determine the prevalence of intracranial plaques and stenoses and their causal role in patients with fatal stroke. Intracranial atherosclerosis is considered to be a rare condition with a severe prognosis. However, disease prevalence may be underestimated due to lack of appropriate diagnostic procedures. Methods-We performed a systematic analysis of intra-and extracranial arteries, the aortic arch, and the heart in 339 consecutive autopsies of patients with stroke. Clinical history, risk factors, imaging data, and general autopsy reports were analyzed. Patients with brain hemorrhage (nϭ80) were used as control subjects. Results-Intracranial plaques and stenoses occurred in 62.2% (95% CI, 56.3 to 68.1) and 43.2% (95% CI, 37.2 to 49.3) of patients with brain infarction, respectively, compared with 48.8% (PϽ0.05) and 17.5% (PϽ0.001) of patients with brain hemorrhage, respectively. In the 43% of patients with brain infarction with at least one intracranial plaqueinducing luminal stenosis graded Ͼ30%, the stenosis was considered to be causal in 5.8% of cases (nϭ15) because of superimposed clot on ulcerated plaques; 27% of these patients had stenoses graded 30% to 75%. In multivariate analyses, diabetes and male sex were significantly associated with intracranial plaques and stenosis. History of myocardial infarction was significantly associated with intracranial plaques and previous stroke was associated with intracranial stenosis. Conclusions-Intracranial plaques and stenoses are highly prevalent in fatal stroke, and stenoses graded 30% to 75% may be causal. New arterial wall imaging techniques should be used to reevaluate the frequency and role of intracranial artery plaques in living patients with stroke.

Recurrence in Intracranial Atherosclerotic Disease: A Stenosis-based Analysis

“…For instance, in the United States, ICAD is responsible for 8%-10% of ischemic strokes in Caucasians. 9 Nevertheless, as Mazighi et al 10 suggested, in a study on autopsies of patients who died as a consequence of ischemic or hemorrhagic stroke, the real impact of ICAD on Caucasians may be greater than expected. According to Asian studies, ICAD accounts for 33%-50% of all strokes in China, 47% in Thailand, 48% in Singapore, and 10%-25% in Korea.…”

MR Angiography and Imaging for the Evaluation of Middle Cerebral Artery Atherosclerotic Disease

“…8 Stroke risk with severe intracranial artery stenosis appears related to the degree of stenosis with a hazard ratio of 2.03 (P ϭ .0025) of symptom recurrence for severe (Ն70%) stenosis. 24 A prospective study of MCA disease found a 12.5%…”

“…A substantial study of Ͼ300 stroke fatalities in Paris showed that intracranial atherosclerotic plaque occurred in 59% of patients and 37.2% of all patients had intracranial plaque that was stenotic. 8 Specifically, the MCA was diseased in 28.9% of fatal stroke postmortem examinations; of these, roughly half of the plaque was 30%-74% stenotic and one-quarter of the plaque was severely stenotic (Ͼ75%) or completely occlusive. 8 Another postmortem study of patients with MCA territory stroke detected MCA stenosis on the ipsilateral side in 19% and on the contralateral side in 7% of cases.…”

“…8 Specifically, the MCA was diseased in 28.9% of fatal stroke postmortem examinations; of these, roughly half of the plaque was 30%-74% stenotic and one-quarter of the plaque was severely stenotic (Ͼ75%) or completely occlusive. 8 Another postmortem study of patients with MCA territory stroke detected MCA stenosis on the ipsilateral side in 19% and on the contralateral side in 7% of cases. 7 Thus, MCA disease appears frequently in fatal stroke in certain cohorts and may cause substantial stenosis in many patients.…”

“…6 Yet a host of postmortem and imaging studies implicate MCA atherosclerosis as a likely cause of stroke. [7][8][9] Further investigation is necessary to evaluate the prevalence and importance of MCA disease as an etiology of ischemic injury.…”