title: Intravascular ultrasound of symptomatic intracranial stenosis demonstrates atherosclerotic plaque with intraplaque hemorrhage: a case report.
abstract: BACKGROUND
  Intracranial artery stenosis is assumed to represent atherosclerotic plaque. Catheter cerebral arteriography shows that intracranial stenosis may progress, regress, or remain unchanged. It is counterintuitive that atherosclerotic plaque should spontaneously regress, raising questions about the composition of intracranial stenoses. Little is known about this disease entity in vivo. We provide the first demonstration of in vivo atherosclerotic plaque with intraplaque hemorrhage using intravascular ultrasound (IVUS).
  
  
  METHODS
  A 35-year-old man with multiple vascular risk factors presented with recurrent stroke failing medical therapy. Imaging demonstrated left internal carotid artery occlusion, severe intracranial right internal carotid artery stenosis, and cerebral perfusion failure. Cerebral arteriography with IVUS confirmed 85% stenosis of the petrous right carotid artery due to atherosclerotic plaque with intraplaque hemorrhage. Intracranial stent-supported angioplasty was performed with IRB approval. The patient recovered without complication.
  
  
  CONCLUSIONS
  This case supports the premise that symptomatic intracranial stenosis can be caused by atherosclerotic plaque complicated by intraplaque hemorrhage similar to coronary artery plaque. IVUS provides additional characteristics that define intracranial atherosclerosis and high-risk features. To our knowledge, this is the first report of stroke due to unstable atherosclerotic plaque with intraplaque hemorrhage in vivo.
authors.affiliation: Department of Radiology, Columbia University, College of Physicians & Surgeons, Neurological Institute of New York, New York, New York 10032, USA. pmm2002@columbia.edu
authors.forename: Philip M
authors.initials: PM
authors.lastname: Meyers
authors.forename: H Christian
authors.initials: HC
authors.lastname: Schumacher
authors.forename: William A
authors.initials: WA
authors.lastname: Gray
authors.forename: Johanna
authors.initials: J
authors.lastname: Fifi
authors.forename: John G
authors.initials: JG
authors.lastname: Gaudet
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Heyer
authors.forename: Ji Y
authors.initials: JY
authors.lastname: Chong
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008297:Male; D020768:Middle Cerebral Artery / Q000503:physiopathology; D015607:Stents; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial