What is intracranial stenting? How does it work?
The cerebral arteries are large main arteries that provide blood to your brain and head. Intracranial stenting involves placing a stent (small metal coil) in the artery to prop it open and allow blood to flow through the vessel more easily. It is commonly combined with a treatment known as intracranial angioplasty, in which a catheter with a balloon on its tip is gradually inflated in your artery to push it open.
What conditions does this treatment treat?
Intracranial stenting is normally performed to treat stroke as a result of intracranial artery stenosis. Intracranial artery stenosis happens when arteries are narrowed due to a build-up of fatty deposits (atherosclerosis), leading to a reduced blood flow to the brain. Your likelihood of getting atherosclerosis increases with certain risk factors like smoking, high blood pressure, high cholesterol and diabetes.
Intracranial artery stenosis can eventually lead to stroke, if not treated in time.
Intracranial stenting can also be used to treat brain aneurysms, which are bulging arteries that occur where the arterial wall is weak. The enlarged artery inflates in the weak area, and the walls can continue to weaken over time, increasing the risk of a rupture. If they rupture, they cause bleeding into the brain which can be life-threatening.
What is expected during the treatment?
Intracranial stenting uses a stent to keep the artery open and try to prevent it from narrowing again. This stent will remain in place after the surgery.
Only a small incision is made in the groin in order to insert the stent into your artery where the blockage is, which means there will be no surgical scar. During the surgery, X-ray fluoroscopy will be used to guide the stents towards the affected part of the artery. You will be under general anesthesia during the procedure. Compared to the carotid arteries, intracranial arteries are very small and have complicated pathways, so they’re more difficult to navigate with a catheter. So, intracranial stent placement requires more expertise and specialised equipment.
There is a shorter recovery time as compared to other surgery options like intracranial endarterectomy. In an intracranial endarterectomy, an interventional neurologist will directly remove plaque and damaged parts of the artery.
This procedure can be performed as an outpatient procedure, meaning you can return home within the day of the surgery and return to daily activities within the next 48 hours. Thus, this procedure is extremely safe.
How will it improve your condition and affect your life? (e.g. change in QOL, change daily tasks, etc.)
Post-surgery, you will find that your symptoms of intracranial stenosis (neck pain, headaches etc) improve in 1-2 weeks. You will be asked not to engage in any strenuous activity for the first week or so, but everything should return to normal after that.
What are some possible side effects or risks?
In general, this procedure is a safe one, although complications and side-effects are always a possibility. Some possible surgical risks include allergic reactions to the injected material, as well as damage to the blood vessel and minor bruising or heavy bleeding at the site of the catheter insertion. There is also a very small risk of stroke if the aneurysm is ruptured and heavy bleeding occurs.
If not taken care of properly post-surgery, the blockage could return to your artery.
What do I do after I get this treatment?
After the intracranial stenting procedure has been completed, you will probably need to return for a couple of check-ups, but minimal follow-up medication will be required and you can more or less resume your daily activities.
If you have any questions about this procedure, do seek clarification with your doctor and find out whether this treatment is suitable for you.
- Abualhasan, A., Abd-Allah, F., Pero, G., Sobh, K., Mansour, O., El-Serafy, O., & Boccardi, E. (2019). Intracranial Stenting: Is It Still an Option for Treatment of Patients With Intracranial Atherosclerosis? Frontiers in Neurology, 10. https://doi.org/10.3389/fneur.2019.01248
- Intracranial Vessel Stenting. (2015, January 28). Healthgrades. https://www.healthgrades.com/right-care/brain-and-nerves/intracranial-vessel-stenting#:~:text=Your%20doctor%20may%20recommend%20intracranial%20stenting%20for%20you%20under%20the
- Novitzke, J. (2009). A Patient Guide to Brain Stent Placement. Journal of Vascular and Interventional Neurology, 2(2), 177–179. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317336/