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Controllable Risks - Intracranial Atherosclerosis

Hardening of the arteries in the brain - Treatment

What is the treatment?
Intracranial atherosclerosis is hardening of the arteries in the brain. It is usually discovered after a stroke occurs. Experiencing a stroke once means increases the chance of a recurrent stroke. Talk to a doctor about making lifestyle changes that can also slow down the development of atherosclerosis.

Recommended lifestyle changes include:

  • a low-fat, low-cholesterol diet
  • losing weight (if necessary)
  • exercise
  • controlling blood pressure
  • not smoking

A doctor may also suggest medicines to prevent TIAs and stroke. These medicines may include:

  • blood pressure lowering drugs if your blood pressure is high
  • antiplatelet drugs (aspirin, dipyridamole (Aggrenox®) or clopidogrel (Plavix®)) which help keep blood platelets from sticking together to form a clot
  • anticoagulant (blood thinning) drugs such as warfarin (Coumadin™) to prevent clots forming
  • cholesterol-lowering drugs if your bad cholesterol level is high (LDL >100)

If the arteries are greatly blocked, a doctor may suggest either angioplasty and/or stenting to open them up. For both procedures, a thin tube called a catheter is inserted in the groin or thigh area. From there it is threaded up through the body to the site of the diseased artery. A dye is injected into the arteries so that the doctor is able to see the blockage on an X-ray machine.

If angioplasty is performed, a small balloon at the end of the catheter is inflated at the blocked area. The balloon pushes against the built-up plaque and compresses (flattens) it. At the same time it also widens the blood vessel. As a result, the blocked artery opens up and blood flow is restored. If stenting is performed, a small stent (a wire mesh tube) at the end of the catheter is placed in the artery. The stent expands to fit the size and shape of the artery wall. It is designed to open the artery and prevent future blockages.

Angiography - Blocked Artery Stented Artery
An angiogram of a brain artery before and after stenting. Notice how the blood flow was completely blocked before stenting but has been restored after.

Courtesy of Professor M. Hartmann, Division of Neurology, Heidelberg Medical School, Germany

Though both procedures usually require a hospital stay of one or two days, they are not considered surgery. These procedures are typically performed by a neuroradiologist or a neurosurgeon.

For stroke survivors who do not respond to current treatments such as aspirin or blood thinning drugs, angioplasty with stenting is an option. Currently, the Wingspan™ Stent System is the only treatment approved by the Federal Drug Administration for treating intracranial atherosclerotic disease. For more information, ask a doctor or visit Boston Scientific’s website at http://www.bostonscientific.com/WSS.

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