A pathological perspective on the natural history of cerebral atherosclerosis.

TitleA pathological perspective on the natural history of cerebral atherosclerosis.
Publication TypeJournal Article
Year of Publication2015
AuthorsGutierrez, J, Elkind, MSV, Virmani, R, Goldman, JE, Honig, L, Morgello, S, Marshall, RS
JournalInt J Stroke
Date Published2015 Oct

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.

Alternate JournalInt J Stroke
PubMed ID25854637
PubMed Central IDPMC4583838
Grant ListP50 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