A case series of intracranial arterial stenosis in Caucasian patients

Background: Intracranial arterial stenosis (IAS) refers to luminal narrowing of intracranial arteries and is most often due to primary atherosclerosis. Other pathologies such as arterial dissection, vasculitis and Moyamoya syndrome can also be involved. IAS is more prevalent among Asian, African, and Hispanic populations in comparison to Caucasians. Methods: We describe four Caucasian patients who presented with cerebrovascular accidents between 2015 and 2017 and were found to have intracranial arterial stenosis. Results: Three patients presented with Crescendo Transient ischaemic attacks (TIA) and one with Ischaemic Stroke(IS). All the patients were assessed with CT-brain, CT Angiogram(CTA), MRI brain with MR Angiogram(MRA) and Cerebral Diamox study. The TIA patients had clinically relevant IAS on imaging with one of them demonstrating Moyamoya appearances on CTA & MRA and DSA. The IS patient, a 20 year-old male, had proximal MCA stenosis with collateralisation on MRI/ MRA, in addition to an acute left occipital infarct due to left PCA occlusion. All 3 TIA patients had conventional vascular risk factors including Type 2 diabetes mellitus and dyslipidaemia. Two of the TIA patients showed progression of IAS and development of stenosis in new vessels on follow-up scans despite maximum medical therapy (including dualantiplatelets therapy, hypoglycaemic agents and high dose statins). Conclusion: Intracranial arterial stenosis is an important and underrecognised cause of cerebrovascular disease in Caucasian populations. Early recognition of IAS is important in stroke prevention. Patients need monitoring for progression of existing IAS or new IAS and aggressive management of their existing vascular risk factors.