Narrowing of the arteries of the brain, also known as intracranial arterial stenosis, is a major risk factor for stroke. When symptoms persist despite medical therapy, or in selected patients with severe narrowing, revascularization with intracranial angioplasty and stenting of the intracranial arteries may be the best option.
There are many causes of narrowing, or stenosis, of the arteries of the brain. The most common cause is atherosclerosis. Frequently, if atherosclerosis is present elsewhere, such as the legs or the heart, it is also present in the brain.
Intracranial Angioplasty & Stenting
For most patients, medical therapy will include antiplatelet agents in combination with cholesterol lowering medications. In rare situations, patients are treated with anti-coagulation.
In selected patients who either have recurrent symptoms on medical therapy, or high grade narrowing of the intracranial blood vessels, one approach is to perform a procedure to open the blood flow to the brain.
The main procedure for cerebral revascularization at Maimonides is endovascular angioplasty and stenting, performed by the Interventional Neuroradiologists at MMC. Surgical revascularization with bypass is much more morbid, and impossible for certain vessels.
After evaluation with an imaging technique such as CTA, MRA, or DSA, the area of narrowing is identified. Patients can expect to be pre-treated with a course of anti-platelet agents and cholesterol lowering medications for several days prior to the procedure.
The procedure is done under general anesthesia. During the procedure, a balloon is passed over a wire through the narrowed segment of the artery, and inflated to widen the vessel. Immediately after the angioplasty, the balloon is removed and a metallic stent is passed into the artery and deployed to keep the artery from narrowing again. This form of stenting requires significant experience. At Maimonides, we have the largest single operator experience in intracranial stenting with excellent outcomes.
Recovery from the procedure is usually quick, and patients are kept on the pre-procedure medications for a period of 6 months to 1 year.