Natural History of Stenosis From Intracranial Atherosclerosis by Serial Angiography

Akins, Paul T.; Pilgram, Thomas K.; Cross, DeWitte T.; Moran, Christopher J.

doi:10.1161/01.str.29.2.433

Cited by 131 publications

(83 citation statements)

References 35 publications

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“…Similar data were obtained in other angiography studies, which showed high-grade intracranial lesions in 35%-49% of cases. 1,7,13 In our study, we did investigate 2 ICA segments in detail, especially those in which the MR imaging artifact problem frequently occurs and in which angioplasty may not be complicated by an extremely tortuous arterial course. 19 Tandem stenosis of the ICA is of special interest in patients undergoing surgical ICA revascularization or stent placement.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Ischemic stroke due to atherosclerosis of intracranial large arteries has been reported in approximately 8%-29% of adults in general, with a higher prevalence in African and Asian populations. [4][5][6] The intracranial internal carotid artery (ICA) is the most common location for intracranial stenosis of Ͼ50%; such cases compose up to 49% of all intracranial artery stenoses.…”

mentioning

confidence: 99%

“…[4][5][6] The intracranial internal carotid artery (ICA) is the most common location for intracranial stenosis of Ͼ50%; such cases compose up to 49% of all intracranial artery stenoses. 1,7 Patients with severe (Ն70%) intracranial stenosis have a higher risk of stroke than patients with moderate (50%-69%) intracranial stenosis. 8 Treatment of significant stenosis relies on antiplatelet and antithrombotic agents as well as on aggressive lipid-lowering therapies.…”

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confidence: 99%

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Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis

Valaikienė¹,

Schuierer²,

Ziemus³

et al. 2008

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Gradation of high-grade intracranial internal carotid artery (ICA) stenosis poses a challenge to noninvasive neurovascular imaging, which seems critical for angioplasty in the ICA segments C1 and C5. We investigated cutoff values of intracranial ICA stenosis for transcranial color-coded sonography (TCCS) and compared this method with the "gold standard," digital subtraction angiography (DSA).

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis

Valaikienė¹,

Schuierer²,

Ziemus³

et al. 2008

American Journal of Neuroradiology

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“…C erebral arterial stenoses can be caused by a wide range of diseases such as central nervous system infectious or inflammatory vasculitis, 1-3 intracranial atherosclerosis, 4 or vasospasm. 5,6 The diagnosis of intracerebral arterial stenosis can be clinically challenging because the initial presentation is highly variable, with focal to diffuse neurological manifestations and acute to chronic evolution.…”

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confidence: 99%

Evaluation of Hyperintense Vessels on FLAIR MRI for the Diagnosis of Multiple Intracerebral Arterial Stenoses

Iancu

Oppenheim

Touzé

et al. 2003

Stroke

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Background and Purpose-Hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery (FLAIR) has been described in hyperacute stroke patients with arterial occlusion. We sought to determine whether HVS was more frequent in patients with intracerebral arterial stenoses than in those without stenosis regardless of the presence of a brain infarct. Methods-In this case-control study (19 symptomatic patients with multiple intracerebral arterial stenoses compared with 19 age-matched asymptomatic patients without stenosis), we looked for HVS (ie, focal or tubular hyperintensities in the subarachnoid space) on FLAIR images. We compared the proportion of HVS-positive patients in the 2 groups and evaluated the concordance between the arterial distribution of stenoses on angiogram and that of HVS on FLAIR. Results-HVS was found in 13 of 19 patients (68%) in the study group and 1 of 19 control patients (5.2%) (PϽ0.0001).The concordance between the territorial distribution of stenoses on angiogram and HVS on FLAIR was higher for the right and left middle cerebral artery (ϭ0.6 and 0.63, respectively) compared with the right and left anterior cerebral artery (ϭ0.35 and 0.2, respectively). HVSs were observed in 1 of 7 patients with posterior cerebral artery stenoses on angiogram. HVSs were seen equally in patients with acute focal (7 of 10) or diffuse (6 of 9) cerebral involvement. In the 6 HVS-positive patients with acute stroke confirmed by MRI, additional HVSs were observed in a different arterial territory than that of the stroke lesion.

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“…26 Because the progression of MCA stenosis appears to be quite common, suggested by 61% serial angiography progression of stenosis during approximately 2 years, routine monitoring of stenosis with time may be even more important than in carotid disease. 27 Knowing the prognosis of particular types and degrees of stenotic MCA disease is important in determining target populations for angioplasty, stent placement, or medical management.…”

Section: Risk Management and Outcomesmentioning

confidence: 99%

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

Degnan

Gallagher

Zhang

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY:Intracranial atherosclerotic disease may constitute the most common cause of ischemic stroke worldwide; yet, in the developed world, imaging research has largely focused on extracranial atherosclerosis. Many studies in populations of Asian, African, and Hispanic descent demonstrate the preponderance of intracranial stenosis compared with carotid stenosis. This review examines the clinical presentations of MCA atherosclerosis and stenosis and the use of noninvasive MR imaging in the assessment of intracranial vasculature. MRA is a well-validated technique that offers great advantage over traditional angiography. Advances in high-resolution MR imaging of MCA stenosis have the potential to yield excellent visualization of plaque. Future developments in high-resolution MR imaging to depict intracranial atherosclerosis are explored in this review; these advances will guide endovascular therapy and the comparison of novel interventions.ABBREVIATIONS: TOF ϭ time-of-flight; TCD ϭ transcranial Doppler S troke is a common cause of morbidity and mortality, with cerebrovascular disease constituting the second most frequent cause of death worldwide.1 While the burden of cerebrovascular disease in the developing world is receiving greater attention, its importance is underestimated.2 Intracranial atherosclerotic disease is reaching greater clinical prominence as potentially the greatest contributor to the burden of cerebrovascular disease worldwide.3 Previously, atherosclerotic disease within intracranial vessels was not well-appreciated clinically, perhaps due to the inability to visualize the MCA noninvasively or the greater emphasis on the more easily imaged carotid arteries. In an early study of MCA syndromes, Lhermitte et al 4 alleged that "atherosclerotic thrombosis of MCA is probably a rare event and the primary cause . . . lies in the proximal ICA . . . for an almost inaccessible artery appears to be of little significance." Thus, early investigations established a precedent of emphasizing extracranial atherosclerosis at the expense of investigation of other manifestations of cerebrovascular disease.In examining only extracranial disease, investigators may be detecting only advanced atherosclerosis. Some argue that MCA disease may precede extracranial atherosclerosis; this sequence is suggested by the lack of substantial carotid stenosis in a group of patients with intracranial atherosclerosis, while nearly all those with extracranial stenosis also had concomitant intracranial stenosis.5 Therefore, detecting intracranial atherosclerosis may enable clinicians to intervene earlier.There is much controversy about the degree of MCA stenosis responsible for stroke, with some groups arguing that MCA stenosis is not important in the white population on the basis of a small TCD sonography study.6 Yet a host of postmortem and imaging studies implicate MCA atherosclerosis as a likely cause of stroke.7-9 Further investigation is necessary to evaluate the prevalence and importance of MCA disease as an etiology of ischemic...

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Natural History of Stenosis From Intracranial Atherosclerosis by Serial Angiography

Cited by 131 publications

References 35 publications

Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis

Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis

Evaluation of Hyperintense Vessels on FLAIR MRI for the Diagnosis of Multiple Intracerebral Arterial Stenoses

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

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