Intracranial atherosclerosis

Your brain contains a network of arteries – blood vessels that provide it with oxygen-rich blood. Intracranial atherosclerosis disease (ICAD) – sometimes called “hardening of the arteries” – occurs when these arteries become clogged with a sticky substance called plaque, made up of deposits of fat and cholesterol. This limits blood flow to your brain and increases your risk of a stroke.

Symptoms

A neurovascular disorder, ICAD generally has no symptoms, and is often discovered only after you’ve had a stroke.

You may be at a higher risk if you’re African American, Hispanic or Asian; if you’re a man; or if you’re over the age of 50. Certain health conditions can also increase your chances of ICAD. These include diabetes, heart disease or arterial disease; obesity; high blood pressure or high cholesterol; and having had a previous stroke or a family history of stroke.

Diagnosis

To diagnose the condition, your doctor may order tests to examine the arteries in your brain. These may include:

• Balloon test occlusion: Your doctor will inflate a balloon inside the affected artery to completely block blood flow, and then check your brain function. This helps determine how the blockage will affect your brain.
• Computed tomographic angiogram (CTA): A special dye is injected into your bloodstream, which allows your doctor to view blood flow on a CT scan.
• Digital subtraction angiography (DSA): An X-ray is performed while dye is injected into your bloodstream. A computer then digitally alters the image to allow a clear picture of the blocked arteries.
• Transcranial Doppler ultrasound (TCD): A probe that generates high-frequency sound waves is placed over your skull. By measuring the change in these waves, your doctor can see the direction and speed of blood flow inside your head.
• Transcranial color-coded sonography (TCCS): This ultrasound test is similar to TCD, but your blood flow is color-coded.
• MRI

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Treatment options

If you have early-stage ICAD, your doctor may recommend medication and lifestyle changes to help decrease your risk of a stroke. However, if your doctor finds a significant blockage in your artery, you may need one of the following treatments for intracranial atherosclerosis:

• Intracranial angioplasty: Your surgeon will insert a balloon into the artery and inflate it to widen the space inside. Then, a stent (an expandable tube) is placed in the space to keep the artery propped open.
• Cerebral bypass surgery (ECA/MCA/STA bypass surgery): First, your doctor will remove a blood vessel from another part of your body. Then he or she will drill a small hole into your skull and surgically connect the new vessel in your brain so blood can flow around the clogged artery, bypassing it entirely.