From the Department of Neurology (P.T.A.) and the Section of
Neuroradiology, Mallinckrodt Institute of Radiology (T.K.P., C.J.M., D.T.C.),
Washington University School of Medicine, St Louis, Mo, and Mercy Healthcare
Sacramento (P.T.A.), Sacramento, Calif.
Correspondence to Paul T. Akins, MD, PhD, Mercy Healthcare Sacramento, 2825 J St, Suite 435, Sacramento, CA 95816. E-mail akins{at}cwnet.com
Background and Purpose—Knowledge of
the natural history of stenoses due to intracranial
atherosclerosis may be useful for evaluating possible
treatments such as angioplasty.
Methods—We retrospectively reviewed records over a 7-year
period to identify patients with intracranial atherosclerotic
stenoses and serial angiograms. Quantitative measurements of
stenoses were made in a blinded manner, and clinical outcomes
were reviewed.
Results—We identified 21 patients with 45 intracranial
stenoses who underwent repeat angiography at an average
interval of 26.7 months. The average stenosis for all
intracranial lesions was 43.9% initially and 51.8% on follow-up
(P=.032). The average stenosis in the
intracranial internal carotid artery (ICA) was stable (51.2% versus
52.6%). The average stenosis in the anterior cerebral artery
(ACA), middle cerebral artery (MCA), and posterior cerebral artery
(PCA) progressed from 32.4% to 49.7% (P=.037). Based
on a minimum 10% change, 20% of intracranial ICA lesions progressed
compared with 61% of ACA, MCA, and PCA lesions. Regression occurred in
14% of the intracranial ICA group and 28% of the ACA-MCA-PCA group.
Cerebrovascular events were infrequent during this period, with 4
transient ischemic attacks and 1 intracerebral
hemorrhage.
Conclusions—Intracranial atherosclerotic stenoses are dynamic
lesions demonstrating both progression and regression.
© 1998 American Heart Association, Inc.
Original Contributions
Natural History of Stenosis From Intracranial Atherosclerosis by Serial Angiography
Key Words: angioplasty • atherosclerosis • cerebral angiography • cerebral ischemia • cerebral ischemia, transient
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