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(Stroke. 2003;34:e170.)
© 2003 American Heart Association, Inc.

Case Report

Histopathological Evaluation of Middle Cerebral Artery After Percutaneous Intracranial Transluminal Angioplasty

H. Christian Schumacher, MD; Kurenai Tanji, MD, PhD; Sundeep Mangla, MD; Philip Meyers, MD; John Pile-Spellman, MD; Arthur P. Hays, MD J.P. Mohr, MD, MS

From the Doris & Stanley Tananbaum Stroke Center, Neurological Institute, New York Presbyterian Hospital, Columbia University (H.C.S., J.P.M.); Division of Neuropathology, Department of Pathology, College of Physicians and Surgeons, Columbia University (K.T., A.P.H.); and Department of Interventional Neuroradiology, New York Presbyterian Hospital, Columbia University (H.C.S., S.M., P.M., J.P-S.), New York, NY.

Correspondence to H. Christian Schumacher, MD, Doris & Stanley Tananbaum Stroke Center, Neurological Institute, New York Presbyterian Hospital, Columbia University, 710 W 168th St, Box 131, New York, NY 10032. E-mail hs775{at}columbia.edu

Background— Intracranial atherosclerosis accounts for 8% to 10% of all ischemic strokes, and intracranial angioplasty is increasingly performed to treat stenotic lesions. We report an autopsy case and discuss the effects of intracranial angioplasty for atherosclerotic arteries.

Case Description— A 77-year-old patient died 9 days after angioplasty of the left middle cerebral artery as a result of cardiorespiratory failure. The patient was anticoagulated before, during, and after the procedure with heparin, aspirin, and clopidogrel. At the site of angioplasty, the densely fibrotic eccentric plaque was displaced from the adjacent media into the lumen, distorting it and forming elongated projections. No local thrombosis, plaque compression, or inflammation was observed. Additionally, an intramural hemorrhage extended from the site of angioplasty into the stenotic proximal inferior division of the left middle cerebral artery.

Conclusions— Histopathological findings after intracranial angioplasty parallel those in other arterial territories. The implications of these pathological findings on the medical and endovascular treatment of intracranial atherosclerosis are discussed.

Key Words: angioplasty • atherosclerosis • autopsy

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