Intracranial Angioplasty

Neurointerventional Radiology Procedures

Intracranial Angioplasty for Stroke Prevention

Blockages in blood vessels in the head (intracranial) are usually caused by hardening of the arteries (atherosclerosis); treatment with medicines is not as effective in keeping the vessel open as it is elsewhere in the body. If the blockage gets too severe, not enough blood will get to that part of the brain and a stroke may occur. Intracranial angioplasty is a method of opening narrowed or blocked blood vessels (arteries) in the head to increase blood flow and decrease the chance of a stroke. A catheter is placed into an artery (usually in the leg, similar to an angiogram of the heart) and threaded up to the vessel with the blockage. A very small catheter with a balloon on the tip is put across the blockage and inflated to open the vessel; sometimes a stent (a metal tube designed to keep the vessel open) is placed. Blood thinners are given during the procedure and for a short time after to keep the vessel open as it starts to heal. Patients can usually go home the next day.

Figure 4.

This is a 63-year-old man who experienced vertebrobasilar TIAs despite therapeutic doses of warfarin. (A) The lateral projection of the right vertebral artery injection of the angiogram revealed a severe proximal basilar artery stenosis (arrow). Imaging (B) immediately after angioplasty revealed a small intimal tear which was (C) healed at 3 months with minimal residual stenosis.

Figure 5.

This 44-year-old man presented with persistent severe vertebrobasilar TIAs with gait unsteadiness, blackout spells, and visual disturbances despite oral anticoagulation. The cerebral angiogram revealed a high-grade left vertebral artery stenosis (arrows, A and B) with (C) the right-sided vertebral artery ending in PICA and no visible posterior communicating arteries. He underwent angioplasty of the left vertebral artery stenosis (arrow, E) and a right-sided OA (arrow) to (D) PICA revascularization procedure. His vertebrobasilar TIAs resolved. TIAs, transient ischemic attacks; PICA, posterior inferior cerebellar artery; OA, occipital artery.