Abstract
Intracranial atherosclerotic disease (ICAD) accounts for 9-15% of ischemic stroke in the United States. Although highly stenotic ICAD accounts for most of the strokes, it is assumed that nonstenotic ICAD (nICAD) can result in stroke, despite being missed on standard luminal imaging modalities. We describe a patient with nICAD who suffered recurrent thromboembolic stroke and TIA but had a negative conventional stroke workup. As a result, they were referred for high-resolution magnetic resonance imaging (HR-MRI) of the arterial vessel wall, which identified a nonstenotic plaque with multiple high-risk features, identifying it as the etiology of the patient's thromboembolic events. The diagnosis resulted in a transition from anticoagulation to antiplatelet therapy, after which the patient's clinical events resolved. HR-MRI is an imaging technique that has the potential to guide medical management for patients with ischemic stroke, particularly in cryptogenic stroke.
References
Mar 17, 2005·Circulation·Halina WhiteRalph L Sacco
Jan 25, 2006·Circulation·Scott E KasnerUNKNOWN Warfarin Aspirin Symptomatic Intracranial Disease Trial Investigators
Apr 6, 2007·Neurology·E FeldmannUNKNOWN Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) Trial Investigators
Nov 24, 2007·Cerebrovascular Diseases·Xiang Yan ChenHo Keung Ng
Mar 1, 2008·Stroke; a Journal of Cerebral Circulation·Mikael MazighiPierre Amarenco
Jun 7, 2008·Stroke; a Journal of Cerebral Circulation·Philip B GorelickDilip K Pandey
Dec 2, 2008·Atherosclerosis·Ming-li LiZheng-yu Jin
Jul 3, 2010·Stroke; a Journal of Cerebral Circulation·Michael MarnanePeter J Kelly
Jul 20, 2010·Atherosclerosis·Wei-Hai XuLi-Ying Cui
Sep 9, 2011·The New England Journal of Medicine·Marc I ChimowitzUNKNOWN SAMMPRIS Trial Investigators
Jun 28, 2013·The New England Journal of Medicine·Yongjun WangUNKNOWN CHANCE Investigators
Aug 31, 2013·Stroke; a Journal of Cerebral Circulation·Ajay GuptaPina C Sanelli
Jan 8, 2014·Circulation·Fabien HyafilPierre Amarenco
Jan 16, 2014·CNS Neuroscience & Therapeutics·Wei-Hai XuShan Gao
Jan 21, 2014·BMC Neurology·Lixin ZhouLiying Cui
Citations
Nov 12, 2016·Journal of Neuroradiology. Journal De Neuroradiologie·Waleed BrinjikjiVance T Lehman
Jan 16, 2016·Journal of Neurointerventional Surgery·Mahmud Mossa-BashaDheeraj Gandhi
Sep 25, 2017·Neuroradiology·Adam de HavenonJ Scott McNally
Oct 17, 2017·Stroke; a Journal of Cerebral Circulation·Mahmud Mossa-BashaChun Yuan
Jan 18, 2019·The British Journal of Radiology·Jason Brett HartmanMahmud Mossa-Basha
Feb 23, 2019·The British Journal of Radiology·Mahmud Mossa-BashaChun Yuan
Sep 22, 2018·Journal of Neurosurgery·Mahmud Mossa-BashaMichael R Levitt
Apr 4, 2017·Neurosurgical Focus·Craig KilburgMin S Park
Oct 7, 2018·Neurology·Yan Nan YuWei-Hai Xu
Sep 2, 2017·Current Atherosclerosis Reports·Konark MalhotraGeorgios Tsivgoulis
Nov 13, 2020·The British Journal of Radiology·Basar SarikayaMahmud Mossa-Basha
Feb 13, 2021·Journal of the American College of Cardiology·Lin TaoHui-Sheng Chen
Apr 28, 2021·Neuroimaging Clinics of North America·Kambiz NaelDavid S Liebeskind