Abstract
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.
Highlights
A high incidence of intracranial stenosis is reported in African, Asian, and Hispanic populations, but not in whites.[9] In a study of 850 Korean patients with ischemic syndromes, 12.6% were found to have isolated MCA disease[16]; an even larger study found that MCA stenosis was the most common type of atherosclerotic lesion in approximately one-third of patients with stroke.[20] MCA stenosis was identified in 36% of Korean patients with small striatocapsular infarcts.[13] Estimates of the responsibility of intracranial stenosis in causing stroke are 33%–50% in China.[9,21,22] Asymptomatic patients with vascular risk factors frequently have significant degrees of intracranial stenosis
The degree of stenosis has been determined on the basis of flow velocity calculated from TCD sonography; this method offers fair assessment of MCA stenosis and may have a place in clinical practice in identifying patients requiring detailed imaging methods such as high-resolution MR imaging.[44,45,46]
Focal arterial wall thickening is seen on high-resolution MR imaging of patients with previously identified MCA stenosis port the use of high-resolution MR imaging in this setting to track disease progression and response to therapy
Summary
A high incidence of intracranial stenosis is reported in African, Asian, and Hispanic populations, but not in whites.[9] In a study of 850 Korean patients with ischemic syndromes, 12.6% were found to have isolated MCA disease[16]; an even larger study found that MCA stenosis was the most common type of atherosclerotic lesion in approximately one-third of patients with stroke.[20] MCA stenosis was identified in 36% of Korean patients with small striatocapsular infarcts.[13] Estimates of the responsibility of intracranial stenosis in causing stroke are 33%–50% in China.[9,21,22] Asymptomatic patients with vascular risk factors frequently have significant degrees of intracranial stenosis.
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