Intracranial Stenting

Intracranial stenting

Intracranial stenosis is the medical terminology that restricts your blood flow to the areas of brain for severe narrowing of a cerebral artery.

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 correlate with risk of stroke.

Treatment

Intracranial stenting is a minimally invasive that opens up very narrowed arteries inside the skull that supply the brain.

When the narrowing of the artery is significant (greater than 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 recommended.

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 little metal tube that is utilized to support the walls of the narrowed arteries. It is frequently used in conjunction with angioplasty.

The doctor places a small plastic tube (catheter) through the artery in the groin and guides it, using x-ray, into the arteries in the neck. In the wake of taking images of the supply route of the artery and estimating the length of the artery, the doctor will pick the right size of the inflatable or stent to utilize. The ballon and/or stent is then delivered carefully 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 technique ranges from 3-10% relying on the medical condition, the patient location of the narrowing and other certainties is different from patient to patient. The specialist will cautiously weigh the danger of the sickness against the disease. If the risk of the disease outweighs the risks of the procedure, then the procedure is recommended.

  • Intracranial Atherosclerosis