What should I do if my brain blood vessels are narrowed?

Cerebral vascular stenosis is a cardiovascular and cerebrovascular disease that generally occurs in middle-aged and elderly people. Due to aging, cardiovascular and cerebrovascular functions decline to a certain extent, which can easily cause some cardiovascular and cerebrovascular diseases. Cerebral vascular stenosis is a very serious disease that may endanger human life at any time.

Causes of cerebral vascular stenosis

There are many causes of cerebral vascular stenosis, and they are related to age. For example, vascular stenosis caused by nodular arteritis usually occurs in people aged 10 to 30 years old, while stenosis caused by arteriosclerosis often occurs in middle-aged and elderly people aged 40 to 80 years old, or even older. Children who suffer from the disease are mostly suffering from congenital vascular abnormalities. Cervical spondylosis is also a predisposing factor for cerebral vascular stenosis.

Treatment of cerebral vascular stenosis

There are three treatments for cerebral artery stenosis: drug therapy, surgical treatment and vascular stent therapy.

If the stenosis of the lumen is less than 50%, we can take medication, mainly aspirin (A), probucol (P) and statins (S). This therapy is referred to as PAS therapy. If the blood vessel stenosis exceeds 50% of the diameter, a carotid endarterectomy surgery or placement of a vascular stent in the narrowed blood vessel is required to expand the lumen to achieve the treatment goal.

Among them, intravascular stent therapy is currently the most widely used. The main advantage of carotid endarterectomy is that it causes little trauma to patients and can treat multiple stenotic lesions at the same time. Therefore, it is particularly suitable for patients who cannot tolerate or refuse surgery, patients whose vascular stenosis recurs after surgery, patients with multiple vascular stenosis, and patients whose stenosis cannot be reached by surgery. These three treatment methods have their own indications, advantages and disadvantages and can complement each other.

Diagnosis of cerebral vascular stenosis

The diagnosis is confirmed based on clinical manifestations and auxiliary examinations. Non-invasive tests: ultrasound and magnetic resonance angiography (MRA). Invasive examination: cerebral angiography.

Ultrasound examination of the brain's blood supply arteries

Combined B-mode ultrasound imaging and transcranial Doppler examination are used to detect stenosis of the cerebral blood supply arteries. Transcranial Doppler is currently the most widely used non-invasive detection method for stenosis of the cerebral blood supply arteries. B-mode ultrasound scanning can display the longitudinal section of the artery in real time, and Doppler examination helps to evaluate the blood flow of the carotid artery and the degree of carotid stenosis based on pre-set parameters.

CT angiography (CTA)

The main purpose is to understand whether there is stenosis, calcified plaques in the extracranial segment of the carotid artery system and its degree and range. If the ultrasound examination method is uncertain, CTA examination can be performed in addition. CTA can accurately display the diameter of the vessel lumen and, if necessary, perform cine display under the conditions of window width 850HU and window level 200HU. It can maximize the distinction between the vessel wall, lumen and soft tissue or calcified plaque. CTA has advantages over MRA in comparative studies before and after carotid artery stent implantation.

Magnetic resonance angiography

1. MRA: It does not require contrast agents and mainly relies on the fluidity of blood to perform vascular imaging. It is a non-invasive examination method. Moreover, the observation range is significantly larger than that of CTA, ranging from the aortic arch to the intracranial cerebral blood vessels.

2. Enhanced MRI scan: The enhanced MRA method is significantly superior to conventional MRA. It is faster and has higher clarity. Its imaging quality is very close to that of angiography.

3. Cerebral angiography

Cerebral angiography is the 'gold standard' for evaluating cerebral blood vessels, but it is an invasive examination and not the preferred examination method. When ultrasound, CTA, TCD and MRA examinations suspect cerebral vascular stenosis (especially intracranial cerebral vascular stenosis), catheter angiography is necessary to confirm the diagnosis. This examination can dynamically and comprehensively observe the blood flow, variation, collateral compensation and integrity of the Willis circle of the cerebral vessels.