Cerebrovascular Disease

Risk factors associated with cerebrovascular disease include:

• Advanced age
• Male
• Family history
• Hyperlipidemia (elevated fats in the blood)
• Hypertension (high blood pressure)
• Smoking
• Diabetes
• Obesity
• Diet high in saturated fat
• Sedentary lifestyle

Head trauma is an additional risk factor for developing a brain aneurysm.

When plaque builds up in the carotid artery, blood flow to the brain may be impaired, increasing a patient’s risk of stroke. A brain aneurysm also increases a patient’s stroke risk. A stroke is damaged brain tissue caused by a vascular problem. There are many potential warning signs for stroke, including:

• A sudden weakness or even paralysis of a leg, arm, or hand
• Transient (lasting a short time) slurring, garbled, or inappropriate speech
• Transient blindness or severe blurring of vision in one eye
• A transient, one-sided facial droop

Other potential warning signs for stroke include blackout spells or severe headaches.

At BWH, our vascular disease specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies.

The presence of a carotid artery narrowing may be suggested by one of the warning signs described above. Many patients, however, will be completely asymptomatic, despite significant narrowing of a carotid artery. In many such patients, a careful physical examination will reveal the presence of an audible bruit (abnormal sound heard through a stethoscope) in the neck, caused by disturbed blood flow through the carotid artery.

When a medical history or physical examination suggests potential carotid artery narrowing, the patient is generally sent for a noninvasive imaging study to evaluate the carotid arteries. These studies may include a duplex ultrasound study or a magnetic resonance angiogram. Both are completely noninvasive and highly accurate tests to determine the presence and extent of carotid artery narrowing. When a carotid artery narrowing of greater than 80 percent is found, consideration for repair of the artery is appropriate.

Patients who have had warning signs for stroke and are found to have significantly narrowed carotid arteries are recommended for artery repair. Asymptomatic patients with severe carotid artery narrowing are selectively recommended for intervention based on their age and overall health status.

Most cerebral aneurysms go undiagnosed until after they have ruptured. In these cases, specialists from our Department of Neurosurgery’s Center for Stroke and Cerebrovascular Diseases will use diagnostic methods to confirm a diagnosis of aneurysm and to help guide treatment. These methods may include one or more of the following tests:

• Cardiac CT angiography
• Cardiac Computed Tomography (CT)
• Cardiac Magnetic Resonance Imaging (MRI)
• Spine fluid analysis

Specialists from the Division of Vascular and Endovascular Surgery develop individualized treatment plans for patients based on:

• Age
• Overall health
• Medical history
• Severity and form of the disease
• Tolerance for specific medications or procedures
• Expectations for course of the disease
• Presence of other conditions

Vascular specialists also recommend medical treatments for carotid artery disease. Along with a modification of lifestyle risk factors, this may include:

Medication

• Antiplatelets (to reduce clots)
• Antihyperlipidemics (to lower fats in the blood)
• Antihypertensives (to lower blood pressure)

Surgery

For more severe carotid artery narrowing, there are two options. Currently, most patients are recommended standard open surgical treatment of the carotid narrowing:

• Carotid endarterectomy is performed through a small incision in the neck and involves a "shelling out" of the plaque from the diseased artery. This procedure removes the plaque from the inside of the artery wall and restores normal blood flow through the artery to the brain. The operation is generally well tolerated and involves a one- to two-day hospital stay.

A new, catheter-based treatment for carotid artery narrowing, which may be offered to patients on a selective basis, is:

• Balloon stent angioplasty During this procedure, a very thin wire and a small balloon are guided to the blockage in the vessel. A balloon is inflated to compress the plaque and open up a channel through the blockage. A stent is then placed in the artery to keep the vessel open. This procedure does not require an incision in the neck and can be performed through a catheter introduced through the groin artery. This procedure also involves a one-day hospital stay.

After either standard carotid endarterectomy or balloon stent angioplasty, patients are followed with serial duplex ultrasound studies to monitor the progress of their carotid arteries.

Treatment for a cerebral aneurysm that has not ruptured and emergency treatment for a ruptured cerebral aneurysm are provided by neurosurgical specialists.