Current knowledge of large vascular occlusion due to intracranial atherosclerosis: focusing on early diagnosis

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Abstract

Intracranial atherosclerosis (ICAS)-related large vascular occlusion (LVO) was an intractable subtype of acute ischemic stroke (AIS), which always needed rescue angioplasty and stenting and complicated the procedure of endovascular recanalization. Diagnosing ICAS-LVO accurately and early was helpful for both clinical treatment and trials. Digital subtraction angiography (DSA) was unable to provide an early and rapid diagnosis of ICAS-LVO based on current studies. A variety of pre-DSA methods had been used to distinguish ICAS-LVO with other subtypes of ischemic stroke, such as medical histories, clinical presentations, computed tomography or angiography (CT/CTA), and magnetic resonance imaging (MRI/MRA). This article briefly reviewed the status quo of the diagnosis and treatment of ICAS-LVO and summarized early diagnostic methods of ICAS-LVO from different aspects.

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Most cited references 65

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Intracranial plaque enhancement in patients with cerebrovascular events on high-spatial-resolution MR images.

Ye Qiao, Steven R Zeiler, Saeedeh Mirbagheri … (2014)

To characterize intracranial plaque inflammation in vivo by using three-dimensional (3D) high-spatial-resolution contrast material-enhanced black-blood (BB) magnetic resonance (MR) imaging and to investigate the relationship between intracranial plaque inflammation and cerebrovascular ischemic events.

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Ischemic Stroke Subtype Classification: An Asian Viewpoint

Bum Kim, Jong Kim (2014)

Proper classification of the causative mechanism of stroke is important for optimizing stroke treatment and assessing prognosis. The primary etiology of stroke differs according to race and ethnicity: emboli originating from the heart or extracranial large arteries are common in Western populations, whereas small-vessel occlusion or intracranial atherosclerosis is more prevalent in Asians. Intracranial atherosclerosis frequently leads to stroke by branch-artery occlusion, and the degree of stenosis in these cases is often <50%. Mild intracranial atherosclerotic stenosis may cause distal embolization, if the atherosclerotic plaque is sufficiently vulnerable. Moreover, high-resolution magnetic resonance imaging studies have identified small plaques causing infarction, even in patients with normal-appearing vascular findings. Such cases, which are prevalent in Asia, could not be classified as large-artery atherosclerosis by previous classification systems. Additionally, single subcortical infarctions, which are usually attributed to lipohyalinotic small-vessel disease, can have other causes, including microatheroma of perforators and atherothrombotic lesions at the parental artery. Single subcortical infarctions associated with parental artery disease or those bordering on the main vessel more often have atherosclerotic characteristics than do those associated with lipohyalinosis of the penetrating artery. In countries where intracranial atherosclerosis is common, such atherosclerotic single subcortical infarctions are predicted to be prevalent. These cases, however, could not be appropriately classified in previous systems. Further effort should be devoted to formulate ischemic stroke classification systems that adequately incorporate results of recent studies and reflect the underling pathologic mechanisms, especially in patients with single subcortical infarction and intracranial atherosclerosis.

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Patterns and Implications of Intracranial Arterial Remodeling in Stroke Patients.

Ye Qiao, Zeeshan Anwar, Jarunee Intrapiromkul … (2016)

Preliminary studies suggest that intracranial arteries are capable of accommodating plaque formation by remodeling. We sought to study the ability and extent of intracranial arteries to remodel using 3-dimensional high-resolution black blood magnetic resonance imaging and investigate its relation to ischemic events.

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Author and article information

Contributors

He Li: lihe2013155@126.com

Peng Liu: 15021590380@163.com

Pei Liu: 18521324783@163.com

Weilong Hua: hua_6872@163.com

Wenjin Yang: yangwenjin@126.com

Yongxin Zhang: yongxinzhang@foxmail.com

Lei Zhang: zhangleichns@163.com

Pengfei Xing: weixpfsmmu@163.com

Yongwei Zhang: zhangyongwei@163.com

Bo Hong: hongbosmmu@vip.126.com

Pengfei Yang: 15921196312@163.com

Jianmin Liu: chstroke@163.com

Journal

Journal ID (nlm-ta): Chin Neurosurg J

Title: Chinese Neurosurgical Journal

Publisher: BioMed Central (London )

ISSN (Print): 2095-9370

ISSN (Electronic): 2057-4967

Publication date (Electronic): 1 October 2020

Publication date PMC-release: 1 October 2020

Publication date Collection: 2020

Volume: 6

Electronic Location Identifier: 32

Affiliations

[1 ]GRID grid.411525.6, ISNI 0000 0004 0369 1599, Department of Neurosurgery, , Changhai Hospital, ; Changhai Road Num. 168, Shanghai, 200433 China

[2 ]GRID grid.411525.6, ISNI 0000 0004 0369 1599, Stroke Center, , Changhai Hospital, ; Changhai Road Num. 168, Shanghai, 200433 China

Article

Publisher ID: 213

DOI: 10.1186/s41016-020-00213-1

PMC ID: 7528346

SO-VID: a37d7a6e-687e-4300-9253-4fbb8275ffb6

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 6 April 2020

Date accepted : 27 August 2020

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Keywords: acute ischemic stroke,ais,intracranial atherosclerosis,icas,large vascular occlusion,lvo,diagnosis,icas-lvo

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Keywords: acute ischemic stroke, ais, intracranial atherosclerosis, icas, large vascular occlusion, lvo, diagnosis, icas-lvo

Current knowledge of large vascular occlusion due to intracranial atherosclerosis: focusing on early diagnosis

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Most cited references 65

Intracranial plaque enhancement in patients with cerebrovascular events on high-spatial-resolution MR images.

Ischemic Stroke Subtype Classification: An Asian Viewpoint

Patterns and Implications of Intracranial Arterial Remodeling in Stroke Patients.

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