Cerebrovascular Diseases

How Does Cerebrovascular Disease Affect Blood Flow to the Brain?

Cerebrovascular diseases can limit the flow of blood that reaches the brain through the arteries. The carotid arteries bring oxygen-rich blood to the front section of the brain. The blood vessels which carry oxygenated blood to the back portion of the brain are called vertebral arteries.
This lack of blood flow to the brain may be caused by:

• Thrombosis: A cerebral thrombosis is a blood clot which develops in an artery that delivers blood to a portion of the brain.
• Embolism: An embolism is when the blood flow of the vessel is impeded by an object such as a blood clot, piece of plaque or air bubble that has floated in the bloodstream until it lodges in the brain. A thrombus can travel and become an embolus.
• Hemorrhage: A hemorrhage is leeding in the brain caused by leaking or burst vessels.
• Stenosis: The carotid blood vessels can narrow, thereby reducing the flow of blood.
• Ischemia: When there is a loss of blood flow to brain tissue, which can be caused by thrombosis and lead to an embolism.

The specific cause of vascular disease in the brain depends on the type of condition, but the majority of cerebrovascular events are caused by atherosclerotic disease. This is the accumulation of plaque that can slow blood flow to the brain and lead to a stroke

Complex Cerebrovascular Conditions Treated at NSPC in New York

The leading cerebrovascular neurosurgeons at NSPC have extensive experience in treating an array of complex cerebrovascular diseases including:

• Aneurysms of the brain
• Cerebral arteriovenous malformations (AVMs)
• Carotid and intracranial stenosis
• Moyamoya disease
• Stroke including hemorrhagic and ischemic stroke
• Our award-winning physicians are highly trained in traditional open surgery, microsurgical treatments, and minimally invasive endovascular procedures.

Cerebrovascular Disease Treatments – Brain Aneurysms

Brain aneurysms
Cerebral aneurysms occur when an artery wall in the brain becomes weak and pouches out. Larger aneurysms are more likely to burst. Both ruptured and unruptured aneurysms can be treated by either open surgical clipping or less invasive endovascular techniques.

Surgical clipping of aneurysms involves attaching a thin, metal clip on the base of the aneurysm to prevent additional blood from filling the space. With endovascular therapy, a small incision is made to allow a very small balloon catheter to enter an artery and travel to the site of the aneurysm. Once there, a coil is put inside to block blood to the aneurysm. A stent may also be employed to strengthen the artery wall.

Carotid stenosis

When atherosclerosis, the buildup of plaque in the arteries, of the carotid restricts the blood to the brain, it is called carotid stenosis. If less conservative treatments such as medications do not halt the intracranial stenosis, your doctor may recommend surgical treatment to repair the narrowing of the blood vessels.

Carotid endarterectomy is the direct surgical removal of plaque from the walls of the carotid artery. A less invasive surgical procedure, carotid angioplasty and stenting involves inserting a balloon-tipped catheter to widen the constricted blood vessel and placing a stent in the artery to keep the artery open.

Stroke

A stroke is a sudden disruption in the flow of blood circulating in the brain. If caused by a blockage, it may be an ischemic stroke. A transient ischemic attack (TIA) is a collection of stroke symptoms that themselves resolve in 24 hours. A hemorrhagic stroke involves bleeding in the brain.

Emergency medical care is critical in treating a stroke. Medications may be introduced to dissolve a clot, to reduce intracranial pressure, to halt vasospasm, or to avert a seizure. Other surgical procedures to repair the blood vessel may be warranted such as

• Carotid endarterectomy,
• Balloon angioplasty and stenting,
• Intracranial bypass,
• Stereotactic surgery, or
• Surgical clipping

to treat ischemic and hemorrhagic strokes.

Brain arteriovenous malformations (AVMs)

An arteriovenous malformation is an abnormal entanglement of veins and arteries. The normal function of arteries is to bring oxygenated blood to the brain or spine and of veins to carry the blood away. But with arteriovenous malformations, an abnormal network of arteries and veins means the oxygen-rich blood in the arteries is not going to the necessary tissue but is redirected to the veins. These weakened blood vessels are more likely to thin and leak blood into the brain than healthy vessels.

Minimally invasive embolization employs neuroendovascular therapy to transport medical glue through a catheter to the AVM site to seal off blood flow to the vascular malformation.

Microsurgical techniques may be recommended for certain cerebral AVMs. This open surgery utilizes a computer-assisted craniotomy to remove a small portion of the skull allowing the neurosurgeon access to the brain. A surgical resection to remove the AVM may also be coordinated with stereotactic radiosurgery to destroy any remaining portion of the AVM.

Stereotactic radiosurgery for cerebral AVMs uses highly focused radiation beams to eradicate lesions. This is a minimally invasive treatment that is bloodless and is usually an outpatient procedure. It can be very effective for smaller AVMs, but results are not immediate. The experienced neurosurgeons at NSPC can come up with a personalized treatment plan that takes into account your unique situation.

Moyamoya disease

This rare, progressive disease involves the narrowing of the carotid artery but is not caused by the accumulation of fatty deposits on the walls of the blood vessel. With Moyamoya disease, the blood vessels at the base of the brains become blocked and new blood vessels develop in an attempt to transport blood.

The surgical treatments for Moyamoya include direct and indirect revascularization procedures to re-establish blood flow to the brain. During an STA-MCA bypass, your surgeon attaches a superficial temporal artery (STA) to the middle cerebral artery (MCA) to restore blood flow. For an EDAS (encephaloduroarteriosynangiosis) procedure, the superficial temporal artery is attached to the brain’s surface, encouraging new vessels to develop. With an EMS (encephalomyosynangiosis), the neurosurgeon places a tiny part of the temporalis muscles from the head and attaches it to the brain’s surface to stimulate proper blood flow.

State-of-the-Art Treatments for Cerebrovascular Disease at NSPC

Our team of NY-based neurosurgeons, neurologists, and interventional neuroradiologists have expertise in diagnosing and the accompanying treatments of complex cerebrovascular diseases. Our neurosurgical practice also has deep expertise in a range of related subspecialties including endovascular therapy of brain aneurysms, neoplasms and cerebral AVMs, acute stroke intervention, and extra-cranial/intra-cranial angioplasty and stenting of obstructions in the brain’s blood vessels.

Our premier neurosurgical group has extensive experience in treating complex cerebrovascular disorders employing computer-assisted cranial surgery and in using less invasive techniques such as endovascular therapy and stereotactic radiosurgery.

The brain specialists at NSPC’s offices in Long Island and the surrounding New York area provide state-of-the-art surgical solutions to cerebrovascular diseases and other cerebral conditions. Contact us to find out how our surgical expertise can improve your health and life.

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