Stroke and Cerebrovascular Team

Comprehensive stroke & Cerebrovascular center

Atherosclerosis

What is atherosclerosis?

Atherosclerosis, or hardening of the arteries, occurs when a sticky substance called plaque builds up in the inner lining of the arteries. This

Angiogram showing significant stenosis of the middle cerebral artery (MCA).
Angiogram showing significant stenosis of the middle cerebral artery (MCA).
 
 
Angiogram after angioplasty and stenting showing resolution of the MCA stenosis.
Angiogram after angioplasty and stenting showing resolution of the MCA stenosis.

causes narrowing or blockage, which reduce blood flow. Atherosclerosis can occur in any artery and is usually described in the coronary arteries (arteries of the heart). But the condition commonly occurs in extracranial arteries supplying the brain (carotid arteries and vertebral arteries) and in the intracranial arteries (anterior and middle cerebral arteries and the basilar artery).

Decreased blood flow to the brain from atherosclerosis can cause transient ischemic attacks (TIAs). Complete blockage can cause stroke.  More than 750,000 new strokes are diagnosed in the United States each year. Up to 25 percent of those may be caused by atherosclerosis of the extracranial or intracranial arteries.

TIAs, or mini-strokes, usually last for less than 24 hours. Common symptoms include weakness or numbness on one side of the body, inability to speak or understand speech, and changes in vision. If the interruption in blood flow lasts longer, stroke can occur.

How is atherosclerosis treated?

Lifestyle modifications and medical treatment and are used if the narrowing is not severe. Life style modifications include cessation of smoking, a healthy diet and exercise. Medications include anticoagulant agents such as aspirin, and lipid lowering medications.

If the narrowing is severe, greater than 50 percent of the vessel diameter, surgery or endovascular therapy may be recommended.

Surgery, or endarterectomy, is performed under general anesthesia on arteries in the neck (carotid arteries). Endarterectomy involves opening the artery and removing the atherosclerotic plaque that is narrowing it. Surgery is rarely performed on intracranial vessels.
 
Endovascular therapy, usually performed with the patient sedated but awake, is a minimally invasive method that involves using a balloon (angioplasty) and stent to push open the wall of the artery from within. Endovascular therapy can be performed on extracranial or intracranial vessels.

MUSC’s dedication to research and understanding of disease processes maintains ongoing participation in the latest multi-center trials comparing medical therapy with stenting to more about atherosclerosis and to determine which patients are best suited for which treatments.

Vessel with stenosisStenosis undergoing angioplasty.
Vessel with stenosisStenosis undergoing angioplasty
   
Stent being deployed across stenosisStent fully deployed across stenosis
Stent being deployed across stenosisStent fully deployed across stenosis
Final result with stent across stenosis
Final result with stent across stenosis
 
 
 

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