Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Intracranial Atherosclerotic


Intracranial Atherosclerotic Disease

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:

  • Age
  • Smoking
  • Diabetes
  • Obesity
  • Lack of exercise
  • High-fat or high-cholesterol diet
  • Family history and genetic factors
  • High blood pressure (hypertension)
  • Elevated fats in the blood (hyperlipidemia)
  • Drinking too much alcohol (more than one drink per day for women, more than one or two drinks a day for men)


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:

  • Confusion
  • Headache
  • Dizziness or fainting
  • Unclear or slurred speech
  • Temporary blurred vision or vision loss
  • Clumsiness or losing coordination
  • Numbness in the face, arm, or leg
  • Sudden weakness on one side of the body
  • Suddenly being unable to move (paralysis) an arm, leg, or one side of the body


In addition to a physical exam, several tests can help determine whether you have intracranial atherosclerosis disease.

  • Transcranial Doppler ultrasound uses sound waves to show your blood vessels and measure how fast your blood flows. It can help determine where there is narrowing or blockage in your artery, and how severe it is.
  • Computerized tomography angiogram (CTA) uses a contrast (dye) to highlight your intracranial arteries. First a dye is injected into a blood vessel, which travels your arteries. Then CT images are taken of your head and neck to look for possible narrowing or blockages.
  • Computerized tomography (CT) scans that don’t use contrast may also be taken of your head to look at brain tissue. This is often used to rule out bleeding or other problems.
  • Magnetic resonance angiography (MRA) combines contrast with magnetic and radio waves to create cross-sectional and three-dimensional images of arteries in your neck and brain.
  • Magnetic resonance imaging (MRI) creates images of your brain tissue without using contrast. This is often used to look for signs of an early stroke or other problems.
  • Cerebral angiogram is a procedure where the surgeon inserts a thin catheter through the groin and threads it into your intracranial arteries. Contrast is then injected through the catheter to help the arteries show up on detailed X-rays.

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.

Treatment Options

Houston Methodist offers cerebral angioplasty and stenting, and bypass surgery to treat intracranial atherosclerosis.

Cerebral Angioplasty and Stenting

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.

Cerebral Artery Bypass Surgery

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.

Recovery and Rehabilitation

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.

Additional Resources

National Stroke Association
American Heart Association
National Heart, Lung, and Blood Institute