Intracranial Vessel Stenting
Intracranial vessel stenting, or simply intracranial stenting, is a minimally invasive procedure to treat severe cerebral artery stenosis. Cerebral artery stenosis is a narrowing of the arteries that supply blood to the brain. It increases the risk of stroke. Intracranial stenting involves placing a wire mesh tube (stent) in a narrowed artery. The stent expands to open the artery. It stays in place to prevent more narrowing. Doctors often perform intracranial stenting with intracranial angioplasty to prevent stroke.
Intracranial stenting is only one method used to treat cerebral artery stenosis and reduce the risk of stroke. Discuss all of your treatment options with your doctor to understand which options are right for you.
Other procedures that may be performed
Your doctor may perform other procedures in addition to intracranial stenting. These include:
Angiography, which allows your doctor to take a picture or image (called an angiogram) of your blood vessels
Intracranial angioplasty, which involves expanding a balloon on the tip of the catheter. This opens the artery before placing the stent.
Your doctor may recommend intracranial stenting to treat severe cerebral artery stenosis. Cerebral artery stenosis results from atherosclerosis, a build-up of fatty deposits on artery walls. These deposits harden into plaque and narrow your arteries.
Narrowed arteries do not deliver a normal amount of blood to the brain. This can cause transient ischemic attacks (TIAs). A TIA is a group of temporary stroke-like symptoms that are a warning sign of stroke. Serious plaque buildup increases the chance that a blood clot will form, which can totally block the artery causing more TIAs and even a stroke.
Your doctor may recommend intracranial stenting for you under the following conditions:
Narrowing of an intracranial artery is severe, greater than a 50% blockage.
There is insufficient blood supply to an area of the brain.
You had a stroke while on treatment with medications.
Your cerebral artery stenosis has not responded medications, such as aspirin or blood-thinning drugs, and you continue to have TIA symptoms.
Ask your doctor about all of your treatment options and consider getting a second.
Neuroradiologists and neurosurgeons perform intracranial stenting. Neuroradiologists specialize in diagnosing and treating diseases and conditions of the brain, spine, head, neck and nerves using radiation and other imaging technologies. Neurosurgeons specialize in surgical treatment of conditions and diseases of the brain and spinal cord.
Your intracranial stenting will be performed in a hospital angiography suite. The procedure generally includes these steps:
You dress in a patient gown and lie on a procedure table.
Your team inserts an IV to provide fluids and medications.
Your team attaches devices to monitor your heart rate and blood pressure.
Your team runs blood tests to check kidney function and blood clotting.
You receive IV medication (a light sedative) to make you drowsy and relaxed. You may have deeper sedation or anesthesia through an intravenous (IV) line. In this case, you are more relaxed and unaware of the procedure and may not remember it.
Your team shaves, cleans and numbs your groin. Then your doctor makes a small incision.
Your doctor inserts a catheter and guide wire through the incision into an artery and feeds it into the diseased blood vessel in the brain.
Your doctor injects a contrast agent through the catheter into the artery to make the blockage visible on X-rays (angiography).
Your doctor may open the narrowed area of the artery by inflating a balloon on the tip of the catheter (angioplasty). This flattens the plaque and widens the artery.
Your doctor places a mesh tube (stent) to further open the artery and keep it open.
The team takes more X-rays to confirm that blood is flowing as expected.
Your doctor removes the catheter and closes the small catheter site.
Will I feel pain?
Your comfort and relaxation is important to you and your care team. You may feel a pinch or pin prick pain during the IV placement and brief stinging during numbing of the catheter insertion site. You may also feel pressure as your doctor makes the incision and inserts the catheter.
You will receive enough sedative medications to keep you relaxed and comfortable. Tell your doctor or care team if you are uncomfortable.
As with all procedures, intracranial stenting involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications of intracranial stenting can occur during the procedure or recovery. Because of these risks, angioplasty and stenting is typically reserved for patients with severe stenosis that doesn’t respond well to medication.
Risks and potential complications of intracranial stenting include:
Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing
Damage to an artery from the catheter or stent
Exposure to ionizing radiation, which may be harmful in excessive doses
Kidney injury from the contrast agent, especially if you already have kidney problems
Recurrence of artery narrowing or blockage
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor or radiologist if you are nursing or there is any possibility that you may be pregnant
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
You are an important member of your own healthcare team. The steps you take before your intracranial stenting can improve your comfort and outcome. You can prepare for intracranial stenting by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Following all instructions about eating and drinking before intracranial stenting
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. You doctor will give you specific instructions about taking your medications.
Questions to ask your doctor
Preparing for intracranial stenting can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before intracranial stenting and between appointments.
It is also a good idea to bring a list of questions to your appointments. Common questions include:
Why do I need intracranial stenting? Are there any other options for diagnosing or treating my condition?
Will I have intracranial angioplasty with my stenting procedure?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How should I take my medications?
How will you treat my pain?
What other tests or treatments might I need?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
Knowing what to expect after intracranial stenting can help you get back to your everyday life as soon as possible.
How will I feel after the intracranial stenting?
You may have mild drowsiness from the sedative medications after intracranial stenting. It is unlikely that you will feel pain. It is common to have mild tenderness and bruising at the catheter incision site. Tell your doctor or care team if you are uncomfortable.
Your activities will be restricted following intracranial stenting. You may take new medications to help prevent blood clots and spasms in your arteries. Follow your doctor’s instructions for eating, drinking, resting, and taking medications after intracranial stenting.
Intracranial stenting, along with intracranial angioplasty, can eliminate symptoms of transient ischemic attacks (TIAs), such as dizziness, weakness, numbness, and paralysis. It can also reduce your risk of stroke. However, it does not cure atherosclerosis, which causes cerebral artery stenosis. Your doctor will likely prescribe medications and lifestyle changes to treat atherosclerosis and prevent more narrowing of your arteries and a stroke.
When can I go home?
Most people stay one to two days in the hospital for observation after intracranial stenting. You will go home when your doctor decides that your condition is stable.
You will need a ride home and will need to take it easy for a few days. You should avoid heavy lifting and strenuous exercise as directed by your doctor.
When should I call my doctor?
It is important to keep your follow-up appointments after intracranial stenting. You will need regular imaging tests to check the blood flow in the intracranial arteries. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Numbness, coolness, or color change in the leg on the side the catheter was inserted
Pain that is not controlled by your pain medication
Slurred speech or drooping of half of the face
Unexpected swelling, redness or warmth around your incision
Weakness or trouble moving an arm or leg