Intracranial Stenosis

Cerebral Stenosis or Intracranial Atherosclerotic Disease (ICAD)

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Duke's experts identify and treat intracranial stenosis, which occurs when blood flow to the brain is restricted by narrowed arteries or plaque buildup (atherosclerosis) in the small twisting vessels deep within the brain. These blockages can greatly increase your risk of stroke. Neurologists, neurosurgeons, and radiologists use sophisticated imaging to diagnose the severity of your condition and aggressively treat stenosis to reduce your risk of stroke or brain damage. If surgery is recommended, our highly skilled neurosurgeons perform minimally invasive or traditional surgery to open blockages and restore blood flow.

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Transcranial Doppler Ultrasound
This specialized ultrasound uses sound waves to examine blood flow within your brain. This noninvasive, painless test takes about 30 minutes.

MRI or CT Scans
High-resolution images of brain vessels indicate where the brain's blood supply may be restricted by a narrowed or blocked artery. These can be performed with or without contrast dye. These tests take about 30 to 60 minutes and are virtually painless. When MRI or CT scans are used to examine blood vessels (angiograms), they are called MRAs and CTAs.

Cerebral Angiography
Through a small incision, a catheter is inserted into a large artery and threaded through the circulatory system. A contrast dye is injected, which highlights areas of concern. This test takes about an hour.

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Your symptoms and condition will indicate whether cholesterol-lowering drugs, high blood pressure medications, and/or blood thinners should be prescribed to lower your risk for serious complications.

Intracranial Balloon Angioplasty and Stenting

A neurosurgeon makes a small incision, inserts a catheter, and guides it through your circulatory system to the blocked artery. Next, a small, flexible balloon is inflated, pushing plaque back against the artery walls and opening the blockage. Finally, after the balloon is deflated, a small stent is placed, which reinforces the vessel walls and helps keep it open. This procedure is ideal for people who have moderate to severe stenosis. 

Cerebral Artery Bypass

Through an open incision in the skull, neurosurgeons reroute blood flow around the blocked artery using a replacement blood vessel from another part of your body. The new artery bypasses the damaged blood vessel and restores healthy blood flow in the brain. This procedure is ideal for people with severe (100%) stenosis.

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Why Choose Duke

Emergency Diagnosis and Response
Many cerebrovascular diseases aren’t diagnosed until after a serious complication occurs. Our team is the region's leading resource for brain health emergencies, including stroke. Speed of treatment is critical for recovery, and our policies and processes for stroke care have been recognized by The Joint Commission.

Advanced Training and Experience
Our highly specialized physicians and surgeons have completed additional years of training for intracranial stenosis treatment and are experts in their fields.

A Team Approach
Your medical team includes specially trained radiologists who capture and interpret images of blood vessels in your neck and brain as well as neurologists who are experts in treating brain conditions. If you require surgery, our highly skilled neurosurgeons -- who have undergone advanced training in this type of complex brain surgery -- will choose and perform the procedure that's best for you. We are experts in techniques that repair veins and arteries, reduce bleeding, and restore a healthy blood flow. We work together to create the treatment plan that's best for you.

Diagnostic and Imaging Expertise
We use the latest diagnostic and imaging technologies quickly and effectively. These tools enhance our ability to review your medical situation and present the safest and best treatment options.

Access to the Latest Research
Our doctors and surgeons participate in clinical trials to determine the best way to treat brain stenosis. You may be eligible to participate and have access to the latest treatment options, which may not be widely available.

Best Hospital for Neurology, Neurosurgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our neurology and neurosurgery program is nationally ranked, and the highest-ranked program in North Carolina by U.S. News & World Report for 2023–2024.

This page was medically reviewed on 04/25/2022 by