Histopathological evaluation of middle cerebral artery after percutaneous intracranial transluminal angioplasty.
BACKGROUND
Intracranial atherosclerosis accounts for 8% to 10% of all ischemic strokes, and intracranial angioplasty is increasingly performed to treat stenotic lesions. We report an autopsy case and discuss the effects of intracranial angioplasty for atherosclerotic arteries.


METHODS
A 77-year-old patient died 9 days after angioplasty of the left middle cerebral artery as a result of cardiorespiratory failure. The patient was anticoagulated before, during, and after the procedure with heparin, aspirin, and clopidogrel. At the site of angioplasty, the densely fibrotic eccentric plaque was displaced from the adjacent media into the lumen, distorting it and forming elongated projections. No local thrombosis, plaque compression, or inflammation was observed. Additionally, an intramural hemorrhage extended from the site of angioplasty into the stenotic proximal inferior division of the left middle cerebral artery.


CONCLUSIONS
Histopathological findings after intracranial angioplasty parallel those in other arterial territories. The implications of these pathological findings on the medical and endovascular treatment of intracranial atherosclerosis are discussed.
Schumacher
H Christian
HC
Doris & Stanley Tananbaum Stroke Center, Neurological Institute, New York Presbyterian Hospital, Columbia University, 710 W 168th St, Box 131, New York, NY 10032, USA. hs775@columbia.edu
Tanji
Kurenai
K
Mangla
Sundeep
S
Meyers
Philip
P
Pile-Spellman
John
J
Hays
Arthur P
AP
Mohr
J P
JP
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D000925:Anticoagulants / Q000627:therapeutic use; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000209:etiology; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D002537:Intracranial Arteriosclerosis / Q000473:pathology*; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D020768:Middle Cerebral Artery / Q000473:pathology*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D017211:Treatment Failure; D017585:Ultrasonography, Doppler, Transcranial
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors