A pathological perspective on the natural history of cerebral atherosclerosis.
Title | A pathological perspective on the natural history of cerebral atherosclerosis. |
Publication Type | Journal Article |
Year of Publication | 2015 |
Authors | Gutierrez, J, Elkind, MSV, Virmani, R, Goldman, JE, Honig, L, Morgello, S, Marshall, RS |
Journal | Int J Stroke |
Volume | 10 |
Issue | 7 |
Pagination | 1074-80 |
Date Published | 2015 Oct |
ISSN | 1747-4949 |
Keywords | External |
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. |
DOI | 10.1111/ijs.12496 |
Alternate Journal | Int J Stroke |
PubMed ID | 25854637 |
PubMed Central ID | PMC4583838 |
Grant List | P50 AG008702 / AG / NIA NIH HHS / United States R01 MH064168 / MH / NIMH NIH HHS / United States R25 MH080663 / MH / NIMH NIH HHS / United States U24 MH100931 / MH / NIMH NIH HHS / United States |