Pathology-based brain arterial disease phenotypes and their radiographic correlates
- PMID: 38395095
- DOI: 10.1016/j.jstrokecerebrovasdis.2024.107642
Pathology-based brain arterial disease phenotypes and their radiographic correlates
Abstract
Introduction: Brain arterial diseases, including atherosclerosis, vasculitis, and dissections, are major contributors to cerebrovascular morbidity and mortality worldwide. These diseases not only increase the risk of stroke but also play a significant role in neurodegeneration and dementia. Clear and unambiguous terminology and classification of brain arterial disease phenotypes is crucial for research and clinical practice.
Material and methods: This review aims to summarize and harmonize the terminology used for brain large and small arterial phenotypes based on pathology studies and relate them to imaging phenotypes used in medical research and clinical practice.
Conclusions and results: Arteriosclerosis refers to hardening of the arteries but does not specify the underlying etiology. Specific terms such as atherosclerosis, calcification, or non-atherosclerotic fibroplasia are preferred. Atherosclerosis is defined pathologically by an atheroma. Other brain arterial pathologies occur and should be distinguished from atherosclerosis given therapeutic implications. On brain imaging, intracranial arterial luminal stenosis is usually attributed to atherosclerosis in the presence of atherosclerotic risk factors but advanced high-resolution arterial wall imaging has the potential to more accurately identify the underlying pathology. Regarding small vessel disease, arteriosclerosis is ambiguous and arteriolosclerosis is often used to denote the involvement of arterioles rather than arteries. Lipohyalinosis is sometimes used synonymously with arteriolosclerosis, but less accurately describes this common small vessel thickening which uncommonly shows lipid. Specific measures of small vessel wall thickness, the relationship to the lumen as well as changes in the layer composition might convey objective, measurable data regarding the status of brain small vessels.
Keywords: Arteriosclerosis; Atherosclerosis; Brain arterial disease; Brain imaging; Dolichoectasia; Neuropathology.
Copyright © 2024. Published by Elsevier Inc.
Conflict of interest statement
Declaration of competing interest JG has received NIH grant funding, compensation for contributions to an UpToDate article on intracranial atherosclerosis and as expert witness. TNT has received compensation for contributions to an UpToDate article on intracranial atherosclerosis; and consultant fees for serving on a blinded clinical events adjudication committee for Gore. BLH has received fees from Proprio Vision, Galaxy Therapeutics, and Progressive Neuro; and NIH grant funding for the CAPTIVA trial; non-commercial funding from Brain Aneurysm Foundation and The Aneurysm and AVM Foundation; and current industry support from AstraZeneca and Janssen Pharmaceuticals, which are supplying medications for the CAPTIVA trial. MIC has received NIH grant funding for the CAPTIVA trial. Current industry support from Astra Zeneca and Janssen Pharmaceuticals who are supplying medications for the CAPTIVA trial. Consulting fees from Medtronic and Parexel for participating in a Data Safety Monitoring Board and stroke adjudication committee, respectively. SM has received NIH grant funding. JFA has received grants from the Instituto de Salud Carlos III, Ministry of Science, to conduct research projects on intracranial atherosclerosis (FIS projects PI22-01625, PI19-01398, PI16-01396), support from the Spanish Cooperative Research Network on Stroke (RICORS-ICTUS, RD21/0006/0020), Ministry of Science and industry research support from Astra Zeneca. Grants: MIC, BLH, and TNT receive NIH funding (U01NS117450). JG receives NIH grants (R01AG057709 and R01AG066162). SM receives NIH grants (U24MH100931, R01NS108801)
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