Intracranial stenosis is the medical term for severe narrowing of a cerebral artery that restricts blood flow to areas of the brain.  Such narrowing stems from focal, progressive atherosclerosis of the affected vessel.  Intracranial stenosis is responsible for about 10% of strokes annually, and the rate of recurrent strokes without treatment can be alarmingly high.  Current optimal medical treatment includes antiplatelet or anticoagulation medications such as aspirin or warfarin, anticholesterol agents, control of hypertension, and aggressive control of blood glucose in patients with diabetes.

Diagnosis

Computed tomography (CT) angiography, magnetic resonance (MR) angiography, and catheter-based angiography can be used to visualize the region of vessel narrowing.  Typical areas of intracranial stenosis include the internal carotid artery, middle cerebral artery, vertebral artery, and basilar artery.  Other diagnostic tests can evaluate the adequacy of blood flow to the brain.  Computed tomography (CT) perfusion with and without acetazolamide, positron emission tomography (PET), stable xenon CT, and single photon emission CT (SPECT) are all specialized tools used to evaluate adequate blood flow to the brain. PET also has the ability to evaluate the oxygen extraction fraction, a parameter that correlates with risk of stroke.

Treatment

Intracranial angioplasty and stenting is a minimally invasive way to open up very narrowed arteries inside the skull that supply the brain. When the narrowing of the artery is significant (greater then 70% decrease in diameter) or if the narrowing is causing symptoms (strokes or mini-strokes) despite medical treatment, then intracranial angioplasty with or without stenting is recommeded.

 

When a small balloon is used to slowly open up an artery that is narrowed by “plaque” (artherosclerosis), the procedure is called an angioplasty.
A stent is a small metal mesh tube that is used to buttress the walls of the narrowed artery. It is often used in conjunction with angioplasty.
The doctor places a small plastic tube (catheter) throught the artery in the groin and guides it, using x-ray, into the arteries in the neck. After taking pictures of the artery of interest and measuring the lenght of the narrowed part of the artery, the doctor will choose the correct size of balloon or stent to use. The ballon and/or stent is then delivered carefuly under x-ray guidance to the area of narrowing and used to open up the artery.
The technical success rate is over 95%.
The risk rate of the procedure ranges from 3-10% depending upon the overall medical condition, the patient location of the narrowing and other facts unique to each patient. The doctor will carefully weigh the risk of the disease against the risk of the procedure. If the risk of the disease outweighs the risks of the procedure, then the procedure is recommended. Our doctors go over the risks and natural history of each patient’s disease and the benefis and risks treatment with each patient in detail. Each patient is unique and deserves an indepth analysis and discussion of their unique condition.
  • Intracranial Atherosclerosis