The neurosurgeons at Houston Methodist Hospital Neurological Institute Cerebrovascular Center diagnose and treat many kinds of cerebrovascular conditions, including intracranial atherosclerotic disease.
The blood vessels at the base of your brain can become narrowed by plaque (cholesterol, fatty deposits and other materials). This is called atherosclerosis, stenosis or “hardening of the arteries.” This narrowing can restrict blood flow to the brain and cause a stroke. Intracranial atherosclerotic disease is believed to be the most common cause of stroke worldwide.
Risk factors for intracranial atherosclerosis disease include:
Intracranial atherosclerosis disease can start at a young age, progress slowly, and not cause any symptoms until the arteries are narrow enough to reduce blood flow to the brain. Because this disease often progresses without symptoms, the first signs may be serious, such as a transient ischemic attack (TIA or mini stroke) or stroke. Most people only learn they have intracranial atherosclerosis after having a TIA or stroke. TIA and stroke symptoms may include:
In addition to a physical exam, several tests can help determine whether you have intracranial atherosclerosis disease.
If you are diagnosed with intracranial atherosclerotic disease, our team of specialists will work with you to develop a personalized treatment plan based on the degree of your blockage, your symptoms, and your overall health.
Houston Methodist offers cerebral angioplasty and stenting, and bypass surgery to treat intracranial atherosclerosis.
Cerebral stenting often begins with a balloon angioplasty, where a surgeon inserts a balloon-tipped catheter into an intracranial artery to widen it and flatten the plaque. Then a stent (mesh tube) is placed to keep the artery open and allow more blood to flow through. This minimally invasive procedure is often a successful alternative to bypass surgery for many people.
If you have an intracranial artery that is severely blocked, it may be better treated with cerebral bypass surgery. This surgery is also called an extracranial-intracranial (or EC-IC) bypass. During this microscopic procedure, a neurosurgeon takes a blood vessel from the scalp, leg, or chest and creates a new pathway. The new blood vessel is usually connected to the carotid artery in the neck, then inserted (grafted) above the blocked area to avoid the blockage and increase blood flow to the brain.
To access the brain, the neurosurgeon performs a craniotomy, where a portion of the skull is removed (called a bone flap). The bone flap is replaced after they bypass is complete.
After a cerebral stenting or bypass procedure, you will be taken to a recovery room until you wake up and your vital signs (blood pressure, breathing rate) are stable. Then, you will be taken to a regular hospital room or intensive care unit (ICU) room to further recover. Most patients are able to leave the hospital within a day or two.
When you return home, make sure to follow your surgeon’s advice about returning to your normal activities, taking care of the incision site, and watching out for any warning signs such as fever, chills, unusual pain, or bleeding or swelling at the insertion site. If you’re prescribed medication to prevent clots, be sure to take it as directed.
Be careful if you had a cerebral bypass and wear eyeglasses. Glasses that fit too snugly over the temple area can damage the graft. You’ll need to protect the incision with a gauze pad.
After stenting or surgery, keep any scheduled follow up visits. You may also need to have periodic exams or ultrasounds so your doctors can monitor your condition.