Intracranial Stent and Angioplasty

Intracranial Stent & Angioplasty in Thousand Oaks, CA

Intracranial atherosclerotic stenosis (ICAS) is fairly common among adults in the United States, and it causes a significant portion (roughly 8-10%) of ischemic strokes.

In this condition, blood vessels leading to the brain have narrowed due to plaque formation known as atherosclerosis.  Narrowing of the blood vessels can also occur because of vasospasm, which constricts blood vessels after an aneurysm rupture. Fortunately, either of these problems can be treated by a highly-skilled neurovascular surgeon using intracranial angioplasty and stent.

As a triple-board certified neurosurgeon, Dr. Taqi has years of experience and extensive expertise in treating intracranial stenosis and vasospasm. Because of his own personal history, he knows that when you or your loved one has been diagnosed with a vascular problem in the brain, you may feel overwhelmed, scared, or anxious. Dr. Taqi is compassionate and empathetic, and he will take the time to walk you through your angioplasty and stent procedure and answer any questions you might have along the way.  Contact us today to arrange your consultation in Thousand Oaks or West Hills.

What is ICAD and how does it occur?

Intracranial atherosclerotic disease (ICAD) causes a narrowing of blood vessels in the brain, due to buildup of plaques inside these blood vessels. Plaque formation occurs for several reasons, but generally results from damage to the inner wall of the artery. There are many risk factors for plaque development, or atherosclerosis, including diabetes, high blood pressure, high cholesterol, smoking, obesity, and heart disease.

Stenosis can restrict and prevent optimal blood flow to the downstream area of the brain, causing a transient ischemic attack (TIA) or a stroke. During a TIA, blood flow is temporarily interrupted in the area of the stenosis and then restored a few minutes later, and patients return to normal.  While there are generally no lasting effects from a TIA, this event can be a warning sign of blockage and high risk for stroke. In fact, patients who have had a TIA or stroke due to ICAS have a 12-20% chance of stroke recurrence within 2 years (Qureshi et al 2009).

Though ICAS is most common in older adults, it can occur in younger patients. Scientific studies suggest that Hispanic, African American, and Asian people are more likely than Caucasians to suffer from ICAS.  Additionally, ICAS is associated with high cholesterol. Among those with high cholesterol, patients who take cholesterol-lowering medications are less likely to suffer from ICAS and ischemic stroke (Suri et al 2016).

ICAS can be diagnosed in one of several ways. Patients may have it without knowing until they experience a TIA or a stroke, so it is often diagnosed after one of these events. In order to detect and plan treatment for narrowed blood vessels in the brain, you may have a CT angiogram, a MRA, an angiogram, a transcranial ultrasound, a CT perfusion, or a PET scan.

What is vasospasm?

In addition to ICAS, there can be other causes for narrowing of blood vessels that can interfere with blood flow to the brain.  Another possible cause is vasospasm, or the contraction of the muscles in the arterial wall, narrowing it’s diameter and restricting blood flow. Vasospasm can occur as a natural response to injury of the artery.  Though the contraction of the vessel can be a good thing in that it can prevent bleeding into the brain in a ruptured vessel, it can also restrict flow and cause ischemia and stroke. In this case, vasospasm may also be treated with intracranial angioplasty and stenting.

graphic of brain

How is intracranial stent and angioplasty performed?

Patients with ICAS or vasospasms who have experienced TIA or symptoms of stroke despite medication often choose to have an intracranial stent placed, as this minimally-invasive procedure has been demonstrated to significantly reduce the risk of stroke in most patients (Eskey et al 2018). As Dr. Taqi is fully committed to always offering the most advanced, safe, and effective approaches to his patients, you can rest assured that you are in good hands.

During this endovascular procedure, Dr. Taqi will insert a small, flexible catheter into the femoral artery in the groin. After insertion of the catheter, he will expertly guide it along the connected blood vessels of the body up to the treatment site in the brain. When the catheter has reached the area of stenosis, the angioplasty can be performed.

Angioplasty uses a small balloon that can be inflated once it is in place in the area of stenosis. Inflating the balloon re-opens the vessel and compresses any plaque. The balloon is then deflated and removed, allowing for placement of the stent. The stent is a mesh-like tube that will be placed in the target area to hold open the vessel and maintain blood flow. It will stay in place permanently. The catheter is then removed and the small incision in the groin can be closed

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Recovery from intracranial stent and angioplasty

Fortunately, intracranial angioplasty and stenting does not require opening the skull, and it is considered a minimally-invasive procedure. Because of this, the recovery from the procedure is not extensive. Dr. Taqi advises patients who have had an endovascular procedure such as intracranial angioplasty and stenting to take a few days off from work.  You will stay in hospital for a day and resume most of the normal activities after 72 hrs You should not lift anything heavier than 10 pounds for a few weeks to protect your incision site. Dr. Taqi will let you know when you can resume your normal daily activities.

Intracranial Stent and Angioplasty FAQs

Start by gathering your medical records. Request past scans or imaging results in DVD format, in case records were not electronically shared. It is a good idea to have medical notes from other providers on hand as well. You will need to be able to list all of your current medications, too. Finally, you likely have questions, and new ones may pop up; many of our patients bring in a list of questions to ask during their consultation. Making these preparations will help you have a productive and effective consultation with Dr. Taqi.

Though the intracranial angioplasty and stenting is performed to reduce symptoms or your chances of suffering an ischemic stroke, no surgery is without risk. Patients with significant intracranial stenosis that require angioplasty and stenting may experience blood vessel rupture, loss of blood flow, or stroke.

Intracranial angioplasty and stent is generally recommended for patients who have a high degree of stenosis and have tried medication to manage their ICAS. Depending on the location and extent of your stenosis, Dr. Taqi may recommend other medications or procedures.  

If you have symptomatic intracranial atherosclerotic stenosis or vasospasm after aneurysm rupture, you’ll want the advice of Southern California’s leading stroke specialist and experienced neurosurgeon, Dr. M. Asif Taqi.  Contact us or call 805.242.4884 to schedule your appointment today.

References

Eskey, C.J., Meyers, P.M., Nguyen, T.N., Ansari, S.A., Jayaraman, M., McDougall, C.G., DeMarco, J.K., Gray, W.A., Hess, D.C., Higashida, R.T., Pandey, D.K., Pena, C., Schumacher, H.C.; American Heart Association Council on Cardiovascular Radiology and Intervention and Stroke Council. (2018). Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association. Circulation. 137(21): e661-89.

Qureshi, A., Feldmann, E., Gomez, C.R., Johnston, S.C., Kasner, S.E., Quick, D.C., Rasmussen, P.A., Suri, M.F., Taylor, R.A., Zaidat, O.O. (2009). Consensus Conference on Intracranial Atherosclerotic Disease: Rationale, Methodology, and Results. Journal of Neuroimaging. Supplement 1: 1s-10s.

Suri, M.F., Qiao, Y., Ma, X., Guallar, E., Zhou, J., Zhang, Y., Liu, L., Chu, H., Qureshi, A., Alonso, A., Folsom, A., and B. Wasserman. (2016). Prevalence of Intracranial Atherosclerotic Stenosis Using High Resolution Magnetic Resonance Angiography in the General Population – The ARIC Study. Stroke. 47(5): 1187-93.