Neck and intracranial angioplasty and stenting

Fatty deposits (plaque) can narrow the arteries in the neck (the carotid arteries) or inside the skull. A narrowed artery can reduce the blood flow the brain needs and cause a mini-stroke (TIA) or a stroke. Many people have no symptoms until the first TIA or stroke, and the narrowing is often found by chance, for example when a doctor hears a sound over the neck artery. Treatment for everyone is medicines and lifestyle: antiplatelets, cholesterol medicine, blood pressure and diabetes control, stopping smoking, and exercise. If narrowing in the neck has caused symptoms, opening the artery lowers the chance of another stroke, and it works best soon after symptoms. Two ways are used: surgery to clean out the artery (endarterectomy), or a stent placed through a catheter, in which a balloon (angioplasty) opens the artery and the stent holds it open. Large studies found similar overall results with different risks, and your age and the anatomy of your artery help decide; stenting is a minimally invasive procedure compared with surgery. For narrowing inside the skull, studies found that intensive medical treatment worked better than stenting, so stenting is kept for selected people who keep having symptoms despite the best medicines. Risks include stroke, bleeding, the artery narrowing again, and effects on the heart, and you take antiplatelets for a time afterwards. A TIA can look like sudden loss of vision in one eye, brief weakness or numbness on one side, or brief trouble speaking. Treat it as an emergency even if it passes, because a stroke can cause permanent brain damage or even death.