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Intracranial Atherosclerosis
Anne G. Osborn, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Intracranial atherosclerotic vascular disease (ASVD)
            • Intracranial atherosclerotic stenosis (ICAS)
            • Vessel wall imaging (VWI)
          • Definitions

            • Narrowing or ectasia of intracranial arteries secondary to ASVD

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Alexander MD et al: How far can we take vessel wall MRI for intracranial atherosclerosis? The tissue is still the issue. AJNR Am J Neuroradiol. 41(5):E30-1, 2020
                                            2. Leao DJ et al: Intracranial vessel wall imaging: applications, interpretation, and pitfalls. Clin Radiol. ePub, 2020
                                            3. Arenillas JF et al: Intracranial arterial wall imaging: techniques, clinical applicability, and future perspectives. Int J Stroke. 14(6):564-73, 2019
                                            4. Baek JH et al: Angiographical identification of intracranial, atherosclerosis-related, large vessel occlusion in endovascular treatment. Front Neurol. 10:298, 2019
                                            5. Kern KC et al: Vessel wall imaging of cerebrovascular disorders. Curr Treat Options Cardiovasc Med. 21(11):65, 2019
                                            6. Wang Y et al: Culprit intracranial plaque without substantial stenosis in acute ischemic stroke on vessel wall MRI: a systematic review. Atherosclerosis. 287:112-21, 2019
                                            7. Wang Y et al: Intracranial atherosclerotic disease. Neurobiol Dis. 124:118-32, 2019
                                            8. Xu W: High-resolution MRI of intracranial large artery diseases: how to use it in clinical practice? Stroke Vasc Neurol. 4(2):102-4, 2019
                                            9. Dakay K et al: Symptomatic intracranial atherosclerosis with impaired distal perfusion: a case study. Stroke. 49(1):e10-13, 2018
                                            10. Tan HW et al: Intracranial vessel wall imaging with magnetic resonance imaging: current techniques and applications. World Neurosurg. 112:186-98, 2018
                                            11. de Havenon A et al: High-resolution vessel wall MRI for the evaluation of intracranial atherosclerotic disease. Neuroradiology. 59(12):1193-202, 2017
                                            12. Pu Y et al: Intracranial atherosclerosis: from anatomy to pathophysiology. Int J Stroke. 12(3):236-45, 2017
                                            13. Lehman VT et al: Clinical interpretation of high-resolution vessel wall MRI of intracranial arterial diseases. Br J Radiol. 89(1067):20160496, 2016
                                            14. Gounis MJ et al: Imaging Inflammation in Cerebrovascular Disease. Stroke. 46(10):2991-7, 2015
                                            15. Wardlaw JM et al: What are white matter hyperintensities made of? Relevance to vascular cognitive impairment. J Am Heart Assoc. 4(6):001140, 2015
                                            16. Holmstedt CA et al: Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment. Lancet Neurol. 12(11):1106-14, 2013
                                            17. Samuels OB et al: A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol. 21(4):643-6, 2000
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Intracranial atherosclerotic vascular disease (ASVD)
                                                      • Intracranial atherosclerotic stenosis (ICAS)
                                                      • Vessel wall imaging (VWI)
                                                    • Definitions

                                                      • Narrowing or ectasia of intracranial arteries secondary to ASVD

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Angiographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Alexander MD et al: How far can we take vessel wall MRI for intracranial atherosclerosis? The tissue is still the issue. AJNR Am J Neuroradiol. 41(5):E30-1, 2020
                                                                                      2. Leao DJ et al: Intracranial vessel wall imaging: applications, interpretation, and pitfalls. Clin Radiol. ePub, 2020
                                                                                      3. Arenillas JF et al: Intracranial arterial wall imaging: techniques, clinical applicability, and future perspectives. Int J Stroke. 14(6):564-73, 2019
                                                                                      4. Baek JH et al: Angiographical identification of intracranial, atherosclerosis-related, large vessel occlusion in endovascular treatment. Front Neurol. 10:298, 2019
                                                                                      5. Kern KC et al: Vessel wall imaging of cerebrovascular disorders. Curr Treat Options Cardiovasc Med. 21(11):65, 2019
                                                                                      6. Wang Y et al: Culprit intracranial plaque without substantial stenosis in acute ischemic stroke on vessel wall MRI: a systematic review. Atherosclerosis. 287:112-21, 2019
                                                                                      7. Wang Y et al: Intracranial atherosclerotic disease. Neurobiol Dis. 124:118-32, 2019
                                                                                      8. Xu W: High-resolution MRI of intracranial large artery diseases: how to use it in clinical practice? Stroke Vasc Neurol. 4(2):102-4, 2019
                                                                                      9. Dakay K et al: Symptomatic intracranial atherosclerosis with impaired distal perfusion: a case study. Stroke. 49(1):e10-13, 2018
                                                                                      10. Tan HW et al: Intracranial vessel wall imaging with magnetic resonance imaging: current techniques and applications. World Neurosurg. 112:186-98, 2018
                                                                                      11. de Havenon A et al: High-resolution vessel wall MRI for the evaluation of intracranial atherosclerotic disease. Neuroradiology. 59(12):1193-202, 2017
                                                                                      12. Pu Y et al: Intracranial atherosclerosis: from anatomy to pathophysiology. Int J Stroke. 12(3):236-45, 2017
                                                                                      13. Lehman VT et al: Clinical interpretation of high-resolution vessel wall MRI of intracranial arterial diseases. Br J Radiol. 89(1067):20160496, 2016
                                                                                      14. Gounis MJ et al: Imaging Inflammation in Cerebrovascular Disease. Stroke. 46(10):2991-7, 2015
                                                                                      15. Wardlaw JM et al: What are white matter hyperintensities made of? Relevance to vascular cognitive impairment. J Am Heart Assoc. 4(6):001140, 2015
                                                                                      16. Holmstedt CA et al: Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment. Lancet Neurol. 12(11):1106-14, 2013
                                                                                      17. Samuels OB et al: A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol. 21(4):643-6, 2000