I
ntracranial atherosclerotic disease is a major cause of isch-
emic stroke worldwide and the most common cause in the
however, a shift has taken place toward imaging the intracra-
nial vessel wall rather than the lumen as a result of advanc-
ing knowledge on the development of atherosclerotic plaques.
Nowadays, it is common knowledge that outward arterial
Asian population.
1
Patients suffering from intracranial athero-
In subjects with
sclerosis have a high subsequent stroke risk.
1
asymptomatic middle cerebral artery (MCA) stenosis, the
overall annual stroke risk is 2.8%, whereas in patients with
symptomatic middle artery stenosis the risk is even 4 times
remodeling occurs, enabling plaques to develop without lumi-
nal narrowing.4,5
From histopathologic studies, examining the carotid and
coronary arteries, it is known that plaques containing a large
high.2 For many years, lumenography-based methods were
used to assess intracranial atherosclerotic disease by means
of luminal narrowing, and it was thought that stenosis grade
necrotic core or intraplaque hemorrhage and of a soft compo-
sition are typically at risk for plaque rupture.6–8 Furthermore,
was an accurate reflection of disease burden.
3
In recent years,
several magnetic resonance imaging (MRI) studies have