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Intracranial Atherosclerosis

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Neurovascular Imaging

Abstract

Atherosclerotic and arteriolosclerotic diseases of the cervicocerebral arteries are prevalent across the world, respectively, affecting arteries from large to small and distal arterioles. This chapter is focused on atherosclerotic disease that affects large intracranial arteries, an important cause of ischemic stroke and transient ischemic attack worldwide that requires further understanding. An introduction covers the epidemiology and pathology of intracranial atherosclerosis (ICAS), including both asymptomatic and symptomatic manifestations, and the recurrent risk of symptomatic lesions. This is followed by a detailed discussion on routine and novel imaging methods to evaluate the different aspects of symptomatic ICAS and their roles in stratifying affected patients, followed by a brief summary of recommendations and evidence for treatment of such lesions based on current guidelines.

Imaging methods for diagnosing and evaluating symptomatic ICAS reviewed in this chapter include noninvasive and invasive methods to gauge the severity of luminal stenosis and direct and indirect methods to define the extent and function of collateral circulation. We also reviewed routine and novel methods to reveal the status of the overall and territorial tissue perfusion and to detect the salvageable penumbra. Moreover, there is a discussion on the emerging method of plaque imaging to delineate plaque morphology and constituents and rising methods to directly and indirectly quantify the hemodynamic effects of such lesions. For the particularly high risk of recurrent stroke in symptomatic ICAS, not only the severity of luminal stenosis has been identified as an independent predictor, other characteristics of the lesion revealed by imaging methods as discussed in this chapter may also affect the recurrent risk. Appropriate application and interpretation of these imaging methods in cases suspected of symptomatic ICAS may facilitate reasonable clinical decision making for acute treatment and secondary prevention of such lesions.

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Authors and Affiliations

  1. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR, China

    Xinyi Leng & David S. Liebeskind

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  1. Xinyi Leng
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  2. David S. Liebeskind
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Correspondence to David S. Liebeskind .

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Editors and Affiliations

  1. Department of Radiology, AOU of Cagliari, Monserrato, Cagliari, Italy

    Luca Saba

  2. Neurointerventional Radiology Section, Department of Radiology, NYU Langone Medical Center, New York, NY, USA

    Eytan Raz

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Leng, X., Liebeskind, D.S. (2016). Intracranial Atherosclerosis. In: Saba, L., Raz, E. (eds) Neurovascular Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9029-6_39

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  • DOI: https://doi.org/10.1007/978-1-4614-9029-6_39

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