title: A pathological perspective on the natural history of cerebral atherosclerosis.
abstract: BACKGROUND
  The natural history of intracranial large artery atherosclerosis has been mainly described from lumen-based imaging studies, and much of what is reported to be known about atherosclerosis is derived from non-cerebral arteries.
  
  
  OBJECTIVE
  To test the hypothesis that atherosclerosis is only partially represented by stenosis and that advanced atherosclerosis is more common that severe stenosis in noncardioembolic infarcts.
  
  
  METHODS
  Cerebral large arteries from 196 autopsy cases were studied. The revised American Heart Association classification for atherosclerosis was used to determine the phenotype in each available artery. Cross-sectional lumen stenosis was obtained as defined by the Glagov's method.
  
  
  RESULTS
  As age of cases increased, there was a progressive increment in the frequency of atherosclerotic lesions, rising from 5% of all arteries at age 20-40, to more than 40% at age 60 or older. Stenosis also increased with age: less than 3% of the arteries in those ≤50 years had >40% stenosis, while one out of five arteries in those >80 years had >40% stenosis. In most cases (80%), atherosclerosis and stenosis were directly related. However, one out of five cases with advanced atherosclerosis had <30% stenosis. In arteries supplying brain areas with noncardioembolic infarcts, the majority of segments exhibiting advanced atherosclerosis had lumen stenosis of <40%.
  
  
  CONCLUSIONS
  Although intracranial atherosclerosis is typically associated with stenosis, a substantial minority of cases shows advanced atherosclerosis in the absence of stenosis >40%. Definitions based solely on stenosis may underestimate the extent and role of intracranial large artery atherosclerosis.
authors: Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors: Jose
authors: J
authors: Gutierrez
authors: Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.|Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.
authors: Mitchell S V
authors: MS
authors: Elkind
authors: CVPath Institute Inc, Gaithersburg, MD, USA.
authors: Renu
authors: R
authors: Virmani
authors: Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors: James
authors: J
authors: Goldman
authors: Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors: Lawrence
authors: L
authors: Honig
authors: Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Susan
authors: S
authors: Morgello
authors: Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors: Randolph S
authors: RS
authors: Marshall
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D001921:Brain / Q000473:pathology*; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
keywords: cerebral atherosclerosis; noncardioembolic stroke; stenosis