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Histological Characteristics of Intracranial Atherosclerosis in a Chinese Population: A Postmortem Study
Wen Jie Yang1, Mark Fisher2,3, Lu Zheng1
1Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong.
Insights
Intracranial atherosclerosis is common, but complicated plaques are rare. Middle cerebral artery lesions show distinct features compared to vertebral and basilar arteries, suggesting a unique intracranial atherosclerotic phenotype.
Area of Science:
- Neurology
- Pathology
- Vascular Biology
Background:
- Atherosclerosis in anterior and posterior circulation differs in risk factors and stroke mechanisms.
- Limited research compares pathological features of intracranial atherosclerotic lesions.
- This study characterizes and compares intracranial artery lesions.
Purpose of the Study:
- To characterize pathological features of intracranial atherosclerotic lesions.
- To compare these features among middle cerebral arteries (MCAs), vertebral arteries (VAs), and basilar arteries (BAs).
Main Methods:
- Examination of 128 intracranial arteries from 32 Chinese adults (≥45 years) using histology and immunostaining.
- Analysis focused on MCAs, VAs, and BAs.
- Pathological features including plaque composition and stenosis were assessed.
Main Results:
- Progressive atherosclerotic lesions were found in 71% of arteries.
- Complicated plaque features (hemorrhage, neovasculature, thrombi, macrophage infiltration, calcification) were infrequent.
- MCA lesions showed the most severe luminal narrowing and more eccentric plaques compared to VAs and BAs. Calcification was most common in VAs, and thrombi in BAs.
Conclusions:
- Intracranial atherosclerotic plaques are prevalent but generally not complicated.
- Significant pathological differences exist between MCA, VA, and BA lesions.
- These findings suggest a potentially distinct atherosclerotic phenotype within the intracranial vasculature.
Background:
Anterior and posterior circulation atherosclerosis differ in vascular risk factors and stroke mechanisms. However, few studies have compared the pathological features between these lesions. Using a series of intracranial artery specimens, we characterized the intracranial atherosclerotic lesions and compared pathological features among different arteries of the intracranial vasculature.
Methods:
Intracranial large arteries of 32 consecutively recruited autopsy cases of Chinese adults aged 45 years or older were examined pathologically using routine histology and immunostaining, to characterize the pathological features of the atherosclerotic lesions. We analyzed middle cerebral arteries (MCAs) (both left and right), vertebral arteries (VAs) (side more affected), and basilar arteries (BAs).
Results:
Progressive atherosclerotic lesions were present in 91(71%) of the 128 arteries examined. Features of complicated plaques were infrequently detected: plaque hemorrhage was encountered in 12%, neovasculature in 12%, lumen thrombi in 13%, macrophage infiltration in 20%, and calcification in 25% of arteries. Luminal narrowing of MCA was the most severe, followed by VA; the BA least stenotic (37 ± 25 vs. 30 ± 24 vs. 20 ± 20%, all p < 0.05). MCA had more eccentric (vs. concentric) plaques than VA (69 vs. 25%, p = 0.003) and BA (69 vs. 38%; p = 0.03). Lumen thrombi were more frequent in BA, and calcification most commonly occurred in VA atherosclerotic lesions.
Conclusion:
Intracranial atherosclerotic plaques were commonly present in this sample, but the lesions generally lacked features of complicated plaques. MCA lesions had demonstrable differences compared with VA and BA lesions. Further studies are needed to determine whether these characteristics indicate a distinctive atherosclerotic phenotype for the intracranial vasculature.
