Abstract
Intracranial artery calcification (IAC) was regarded as a proxy for intracranial atherosclerosis (ICAS). IAC could be easily detected on routine computer tomography (CT), which was neglected by clinicians in the previous years. The evolution of advanced imaging technologies, especially vessel wall scanning using high resolution-magnetic resonance imaging (HR-MRI), has aroused the interest of researchers to further explore the characteristics and clinical impacts of IAC. Recent histological evidence acquired from the human cerebral artery specimens demonstrated that IAC could mainly involve two layers: the intima and the media. Accumulating evidence from histological and clinical imaging studies verified that intimal calcification is more associated with ICAS, while medial calcification, especially the internal elastic lamina, contributes to arterial stiffness rather than ICAS. Considering the highly improved abilities of novel imaging technologies in differentiating intimal and medial calcification within the large intracranial arteries, this review aimed to describe the histological and imaging features of two types of IAC, as well as the risk factors, the hemodynamic influences, and other clinical impacts of IAC occurring in intimal or media layers.
Highlights
Calcification is widely located in all vascular beds [1, 2], especially in the advanced stages of atherosclerosis along with intraplaque hemorrhage, hemosiderin deposition, and lumen surface disruption [3]
Non-atherosclerotic medial calcification is predominantly present in both the intracranial internal carotid artery (ICA) and vertebral arteries (VAs) while intimal calcification can occur in all major cerebral arteries
Due to different histological features of intimal and medial calcification, the traditional quantitative measurement could be insufficient to reflect on accurate clinical information, indicating a demand for new measurements by computer tomography (CT) or magnetic resonance imaging (MRI)
Summary
Calcification is widely located in all vascular beds [1, 2], especially in the advanced stages of atherosclerosis along with intraplaque hemorrhage, hemosiderin deposition, and lumen surface disruption [3]. Significant progress has been made in clinical research on intracranial artery calcification (IAC). Calcification score and volume [5], which were initially used for assessing coronary arteries, are widely applied to qualitative and quantitative measurements in exploring the clinical relevance of IAC [6]. In the Rotterdam study, many of the ischemic strokes were either in the vascular territories that were separate from IAC or caused by other conditions, for instance, cardiac source embolism or by the coexisting penetrating artery diseases [4]. Histology-Verified Intracranial Artery Calcification despite the association of IAC and intraplaque hemorrhage [7], calcified atherosclerotic plaques in the middle cerebral arteries (MCAs) seemed to be more stable than the non-calcified plaques [8].
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