Name of the Procedure:

Balloon angioplasty, intracranial (e.g., atherosclerotic stenosis), percutaneous

Summary

Balloon angioplasty is a minimally invasive procedure used to open up blocked or narrowed blood vessels in the brain due to atherosclerosis. A tiny balloon is inflated at the site of the narrowing to widen the artery and improve blood flow.

Purpose

This procedure aims to treat intracranial atherosclerotic stenosis, a condition where arteries within the brain become narrowed due to plaque buildup. The goal is to restore adequate blood flow to the brain, reducing the risk of stroke and other complications associated with poor cerebral circulation.

Indications

• Symptoms such as transient ischemic attacks (TIAs) or minor strokes.
• Severe intracranial arterial stenosis (typically more than 50% narrowing).
• Recurrent symptoms despite medical therapy.
• High risk of stroke based on imaging studies and clinical criteria.

Preparation

• Patients may be instructed to fast for a specified period before the procedure.
• Some medications, particularly blood thinners, may need to be adjusted or temporarily discontinued as directed by the healthcare provider.
• Pre-procedure tests may include blood work, imaging studies (like MRI or CT angiography), and a physical exam.

Procedure Description

1. The patient is typically placed under mild sedation and local anesthesia.
2. A small incision is made, usually in the groin area, to access the femoral artery.
3. A catheter is threaded through the blood vessels to the site of the intracranial stenosis.
4. A tiny balloon at the tip of the catheter is carefully inflated at the narrowed segment of the artery, pressing the plaque against the artery walls to widen the vessel.
5. In some cases, a stent (a small mesh tube) may also be placed to keep the artery open.
6. The balloon and catheter are then withdrawn, and the incision site is closed.

Duration

The procedure typically takes 1-2 hours, but this can vary depending on the complexity and location of the stenosis.

Setting

Balloon angioplasty is performed in a hospital, often in a specialized area like a catheterization lab or an interventional radiology suite.

Personnel

• Interventional neuroradiologist or interventional neurologist
• Nurses specialized in interventional procedures
• Anesthesiologist (if deeper sedation or general anesthesia is required)
• Radiology technicians

Risks and Complications

• Bleeding or hematoma at the catheter insertion site.
• Infection.
• Vessel damage or perforation.
• Arterial re-narrowing (restenosis).
• Stroke or transient ischemic attack (TIA).
• Reaction to contrast dye used during imaging.

Benefits

• Reduced risk of stroke or recurrent TIAs.
• Improved cerebral blood flow.
• Potential for significant neurological improvement within days to weeks after the procedure.

Recovery

• Patients typically stay in the hospital for observation for 1-2 days.
• Instructions will include wound care, activity restrictions, and medications to prevent blood clots.
• Follow-up appointments are necessary to monitor recovery and the success of the procedure.
• Most patients can return to normal activities within a week but should avoid strenuous activities for a longer period as advised by their doctor.

Alternatives

• Medical management with antiplatelet drugs (e.g., aspirin, clopidogrel) and cholesterol-lowering medications.
• Carotid endarterectomy or other surgical options in some cases.
• Lifestyle modifications, including diet, exercise, and smoking cessation.
• Each alternative has its own risks and benefits, and the best option varies depending on the specific patient's condition and overall health.

Patient Experience

During the procedure, patients may feel some pressure at the insertion site but typically do not experience significant pain due to local anesthesia. Post-procedure soreness at the incision site is common, and some discomfort can be managed with pain relievers. Continuous monitoring and supportive care are provided to ensure comfort and detect any immediate complications.