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Case Reports in Radiology
Volume 2015 (2015), Article ID 356582, 4 pages
Case Report

Nonstenotic Culprit Plaque: The Utility of High-Resolution Vessel Wall MRI of Intracranial Vessels after Ischemic Stroke

1Department of Neurology, University of Utah, 175 North Medical Drive, Salt Lake City, UT 84132, USA
2Department of Radiology, University of Washington, 325 9th Avenue, Seattle, WA 98104, USA
3Department of Neurology, University of Washington, 325 9th Avenue, Seattle, WA 98104, USA

Received 11 March 2015; Accepted 16 July 2015

Academic Editor: Ronit Agid

Copyright © 2015 Adam de Havenon et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Intracranial atherosclerotic disease (ICAD) accounts for 9–15% of ischemic stroke in the United States. Although highly stenotic ICAD accounts for most of the strokes, it is assumed that nonstenotic ICAD (nICAD) can result in stroke, despite being missed on standard luminal imaging modalities. We describe a patient with nICAD who suffered recurrent thromboembolic stroke and TIA but had a negative conventional stroke workup. As a result, they were referred for high-resolution magnetic resonance imaging (HR-MRI) of the arterial vessel wall, which identified a nonstenotic plaque with multiple high-risk features, identifying it as the etiology of the patient’s thromboembolic events. The diagnosis resulted in a transition from anticoagulation to antiplatelet therapy, after which the patient’s clinical events resolved. HR-MRI is an imaging technique that has the potential to guide medical management for patients with ischemic stroke, particularly in cryptogenic stroke.