Intracranial Atherosclerotic 

The neurosurgeons at Houston Methodist diagnose and treat many kinds of cerebrovascular conditions, including intracranial atherosclerotic disease.

Intracranial atherosclerotic disease occurs when plaque (cholesterol, fatty deposits and other materials) builds up in the blood vessels at the base of the brain, causing them to narrow and harden. This condition is also referred to as atherosclerosis, stenosis or “hardening of the arteries.” If the narrowing of the artery is severe enough to restrict blood flow to the brain, it can cause a stroke. Strokes may be caused either by clots or by bleeding (hemorrhage) that deprives brain cells of oxygen, leading to their death. Intracranial atherosclerotic disease is believed to be the most common cause of stroke worldwide.

A number of risk factors for intracranial atherosclerotic disease have been identified:

• 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)
• Excessive alcohol consumption 

Symptoms of Intracranial Atherosclerotic Disease
Intracranial atherosclerotic disease can start at a young age and progress slowly. It may not cause any symptoms until the arteries are narrow enough to reduce blood flow to the brain. Because this disease often progresses unnoticed, the first symptoms may occur during a temporary blockage of blood flow to the brain (transient ischemic attack, TIA, or mini stroke) or stroke:

• Confusion
• Headache
• Dizziness or fainting
• Unclear or slurred speech
• Temporary blurred vision or vision loss
• Clumsiness or poor 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

Diagnosis of Intracranial Atherosclerotic Disease
In addition to a physical exam, your doctor may want you to undergo one or more tests that can help determine whether you have intracranial atherosclerotic disease. These tests provide information about the blood vessels and tissue in your brain.

• 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 agent (dye) to highlight your intracranial arteries. First, a dye is injected into a blood vessel, which travels to your arteries. Then CT images are taken of your head and neck to look for possible narrowing or blockages.
• Computerized tomography (CT) scans that do not use a contrast agent (dye) 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 a contrast agent (dye) with magnetic fields and radio waves to create cross-sectional and 3-D images of arteries in your neck and brain.
• Magnetic resonance imaging (MRI) creates images of your brain tissue without using a contrast agent (dye). MRI is often used to look for signs of an early stroke or other problems.
• Cerebral angiogram is a procedure in which the surgeon inserts a thin catheter (flexible tube) through the groin and threads it into your intracranial arteries. A contrast agent (dye) is then injected through the catheter to help visualize the arteries 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, any symptoms and your overall health.

Treatment Options for  Intracranial Atherosclerotic Disease
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, in which a surgeon inserts a balloon-tipped catheter into an intracranial artery to widen it and flatten the plaque. Then a stent (mesh tube) is inserted 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, cerebral bypass surgery may be recommended. 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; it is 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, in which a portion of the skull (called a bone flap) is removed and  replaced after the bypass is complete.

Recovery and Rehabilitation From Treatment for Intracranial Atherosclerotic Disease 
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 moved to a regular hospital room or intensive care unit (ICU) room to recover. Most patients are able to leave the hospital within a day or two.

When you return home, be sure to follow your surgeon’s advice about returning to normal activities, taking care of the incision site and watching for any signs of infection, such as fever, chills, unusual pain or bleeding or swelling at the incision site. If you have been prescribed a 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 will 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 tests so your doctors can monitor your condition.