Cerebral Artery Stenosis

When an artery inside the skull becomes blocked by plaque or disease, it is called cerebral artery stenosis. Arteries anywhere in the body can become blocked. For example, carotid artery stenosis is a narrowing of the large artery in the neck, the carotid, that supplies oxygen-rich blood to the brain. Blocked arteries in the heart often lead to a person having a heart attack or chest pain.

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Blocked arteries in the brain pose special challenges. These arteries are smaller than the carotid arteries and may be buried deep inside the brain, where they are much harder for a surgeon to get to.

Without treatment, a cerebral artery stenosis can greatly increase a person's chance of having transient ischemic attacks (TIAs), mini-strokes or strokes.

Pioneering New and More Effective Treatment of Cerebral Artery Stenosis

Michael Alexander, MD, Director of the Cedars-Sinai Neurovascular Center, was one of the primary interventionalists involved in the National Institutes of Health-funded registry study of the Wingspan intracranial stent.

Unlike the stents used to hold open arteries in other parts of the body, these newer intracranial stents are more flexible than older ones. They expand by themselves without needing a balloon to expand them. This means less equipment is being used inside the delicate arteries of the brain.

The stent placement procedure is demonstrated in the animation below.

This stent is used for patients with severe symptomatic cerebral artery stenosis.

Dr. Alexander also serves on the Steering Committee of the prospective National Institutes of Health clinical trial that is evaluating the therapy called the
SAMMPRIS trial.

Treatment Options Cerebral Artery Stenosis

The first step to treating cerebral artery stenosis is usually medication. Blood thinners such as aspirin or clopidogrel can help prevent a clot from forming in the artery. Statins can help prevent the continued build up of cholesterol plaque in the artery.

If the narrowing of the artery is severe, and doesn't respond to medications or is greater than a 50% blockage, more invasive treatment may be needed. The main options for treating narrowing of the arteries in the brain are:

• Angioplasty to reopen the artery with possible stenting, or
• Cerebral artery bypass surgery.

Angioplasty With Possible Stenting to Treat Cerebral Artery Stenosis

This procedure takes place in the angiography suite. During this procedure, a tube is inserted into an artery in the groin and threaded to the narrowed artery. A small balloon is inserted into the tube. When it reached the narrowed part of the artery, it is opened up. This is called angioplasty.

Then a small, mesh tube device is inserted through the tube in the groin to the area where the narrowing was. This device is called a stent. The stent is put into place and left in the artery. Overtime, the tissues of the artery grow around the stent.