Gutierrez Jose, Elkind Mitchell S V, Virmani Renu, Goldman James, Honig Lawrence, Morgello Susan, Marshall Randolph S
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.
Int J Stroke. 2015 Oct;10(7):1074-80. doi: 10.1111/ijs.12496. Epub 2015 Apr 8.
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.
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.
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.
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%.
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.
颅内大动脉粥样硬化的自然史主要是通过基于管腔的影像学研究描述的，而许多关于动脉粥样硬化的已知信息来源于非脑动脉。
检验以下假设，即动脉粥样硬化仅部分由狭窄代表，且在非心源性梗死中，进展期动脉粥样硬化比严重狭窄更常见。
研究了196例尸检病例的脑大动脉。采用修订后的美国心脏协会动脉粥样硬化分类法确定每条可用动脉的表型。按照Glagov法定义获得横断面管腔狭窄情况。
随着病例年龄的增加，动脉粥样硬化病变的频率逐渐增加，从20 - 40岁时所有动脉的5%上升至60岁及以上时的40%以上。狭窄也随年龄增加：≤50岁者中不到3%的动脉有>40%的狭窄，而>80岁者中五分之一的动脉有>40%的狭窄。在大多数病例（80%）中，动脉粥样硬化与狭窄直接相关。然而，五分之一有进展期动脉粥样硬化的病例狭窄<30%。在供应非心源性梗死脑区的动脉中，大多数表现为进展期动脉粥样硬化的节段管腔狭窄<40%。
虽然颅内动脉粥样硬化通常与狭窄相关，但相当一部分病例在狭窄>40%不存在时显示有进展期动脉粥样硬化。仅基于狭窄的定义可能低估颅内大动脉粥样硬化的范围和作用。
