Digitizing background erasure and angioplasty of the intracranial stenosis bracket

The article was professionally consulted by Specialist Doctor I Tran Cong Trinh - Radiologist - Radiology Department - Vinmec Central Park International General Hospital.

Intracranial stenosis is narrowing of the arteries inside the brain. The buildup of plaque caused by atherosclerosis inside the artery walls reduces blood flow to the brain and causes a stroke. The main medical treatments are to ameliorate risk factors, reduce plaque accumulation and prevent blood clots while stent dilatation is a radical means of revascularization. immediately.

Intracranial stenosis is narrowing of important arteries inside the skull - the blood vessels that supply blood to the brain parenchyma. Intracranial stenosis can occur at any site. Typical areas where arterial stenosis occurs are in the internal carotid artery, middle cerebral artery, vertebral artery, and basilar artery.
The cause of narrowing of blood vessels is the accumulation of plaque on the vessel wall, a consequence of the process of atherosclerosis. Intracranial stenosis can restrict blood flow to areas of the brain, increasing the risk of a stroke at any time, especially in older adults when the atherosclerosis is severe enough to cause other problems. symptom. In addition, other risk factors for intracranial stenosis were similar to those for atherosclerotic cardiovascular disease, including hypertension, dyslipidemia, diabetes, obesity, smoking, and diabetes. use of other forms of tobacco, family history of atherosclerosis, lack of exercise...
The main symptom of intracranial stenosis is having a transient ischemic attack or stroke. The patient has sudden severe headache, paralysis or weakness on one side of the body, difficulty speaking, distorted mouth... and severe condition may be lethargy, coma.
The diagnosis of intracranial stenosis, in addition to the above signs, is also based on cranial imaging tests such as computed tomography angiography, magnetic resonance imaging, transcranial doppler ultrasound. At the same time, basic blood tests are also needed to identify risk factors, thereby helping treating doctors to plan long-term control.
Regarding the treatment of intracranial stenosis, the goal should be to reduce the risk of stroke. Your doctor will recommend a treatment strategy based on factors such as the size of the blockage and your risk of having a first stroke or having a recurrent stroke, including:
Medical treatment: Medicines may be used to minimizing risk factors, such as lowering cholesterol and stabilizing blood pressure. Antithrombotic drugs, such as aspirin, may be recommended to prevent blood clotting in narrowed arteries. Interventional treatment: If there is a large blockage and a high risk of stroke, your doctor may recommend surgical intervention, including endovascular dilation and stenting, and endarterectomy to remove plaque. from narrowed arteries and bypass surgery.

The aim of surgical interventions in intracranial stenosis is to prevent stroke by removing or reducing plaque buildup and widening the artery lumen to allow more blood flow to the brain. In which, stenting dilatation through digital background erasure angiography is a minimally invasive endovascular procedure to compress the plaque against the vessel wall and widen the diameter of the artery.
The term "endovascular" means that the procedure is performed inside the artery with a small and flexible catheter.The catheter will be inserted through the femoral artery in the groin during angiography. The catheter is then inserted into the narrowed intracranial artery. A small balloon is slowly inflated to its maximum at the site of the narrowed artery to increase the lumen diameter by increasing the lumen of the vessel. compresses the atherosclerotic plaque against the artery wall
The goal of this procedure is to reduce lumen narrowing to less than 50%, as a small increase in vessel diameter leads to a very large increase in flow The balloon is then deflated and removed, and an auto-expanding scaffold-like tube called a stent is placed over the plaque to ensure that the lumen remains open. the bracket remains in the artery permanently and the patient will be treated with drugs that help prevent thrombosis in the frame for life. Intracranial stenosis stents are usually indicated for patients with more than 70% severe intracranial stenosis, recurrent transient ischemic attacks, or recurrent stroke symptoms despite treatment. by medicine. This intervention can reduce the degree of vascular stenosis to less than 30% without complications in 60 to 80% of patients.

Because it is a sophisticated technique that requires sophistication, patients and relatives need to be thoroughly explained about the procedure to be prepared, as well as the associated risks, in order to request cooperation. Next, the patient needs to fast, change into appropriate clothes and arrange to lie on his back on the intervention table, place an intravenous line with 0.9% physiological saline solution. Means of monitoring breathing, pulse, blood pressure, electrocardiogram, SpO2 are mounted on the patient and the indicators are displayed on the screen for easy observation. After cleaning the inguinal and genital areas, the doctor will cover the area with a sterile tissue to prepare for intervention. In case the patient is overstimulated and poorly cooperated, it is necessary to consider appointing a sedative to facilitate the process.
At the intervention site, the doctor will administer the usual local anesthetic in most cases from the femoral artery, unless this entrance is not possible, other routes are used. When the anesthetic takes effect, the doctor will insert a needle and insert the catheter into the artery. Under the screen digitizing background erase and contrast, the doctor adjusts and inserts the catheter into the intracranial arterial circulation, looking for a narrow segment with indications for intervention.
When accessing the location and determining the necessary features of the narrowed artery on the DSA, the doctor will proceed to insert the microcatheter and guide wire through the narrowing. Next, the balloon is slowly inflated, and the lumen is widened. Then, when the ball is deflated, a metal support frame will be raised over the narrow spot, unfolding the corresponding bracket to the narrow position.
Finally, the doctor will determine whether the result is satisfactory or not based on the DSA image, the position of the bracket at the narrowed artery segment, the frame is completely open and the lumen is well re-opened. If the plaque thickness is large, an incomplete narrowing of the lumen may be allowed with the degree of stenosis not exceeding 30%. At the same time, the doctor will also check the pulse before, during and after the recirculation is normal, there are no signs of thrombosis or dissection of the vessel wall. At this time, the interventional instruments will be withdrawn. The puncture artery site will be directly pressed by hand for about 15 minutes to stop bleeding and then bandaged for 8 hours. During this time, the patient is limited to bed movement.

As with any intracranial interventional procedure, digital background erasure and stenting may also carry certain risks, including:
Arterial perforation Fracture displacement scaffolding Mucosal damage causing arterial dissection Brain hemorrhage Stroke due to arterial occlusion Complications to anesthesia or use of contrast agents Risk of radiation exposure during DSA

In summary, intracranial stenosis is one of the manifestations of atherosclerotic cardiovascular disease. The treatment of intracranial stenosis, in addition to drugs for long-term control of risk factors, stenting of intracranial stenosis is an endovascular intervention that will be indicated in cases of recurrent or severe stroke. severe narrowing. With the advantages of minimal intervention but good recanalization efficiency, cerebral circulation will improve, minimizing events for the patient.
Before taking a job at Vinmec Central Park International General Hospital, the position of Doctor of Radiology from September 2017, Doctor Tran Cong Trinh worked at Gia Dinh People's Hospital since 2007. -2017. In his role, Dr. Tran Cong Trinh has participated in teaching students, residents, specialists and new doctors to the department.

In April & May 2021, when there is a need for examination and treatment of Intracranial Arteritis at Vinmec Times City International Hospital and Vinmec Da Nang International Hospital, customers will enjoy preferential treatment. Double treatment:
- Free specialist examination and free X-ray
- 50% discount on costs for customers with indications for post-examination treatment. The program is limited to the corresponding technique of each hospital and to customers who perform this treatment technique for the first time at Vinmec.