What is Intracranial Atherosclerotic Disease?
Intracranial Atherosclerotic Disease (ICAD) is the accumulation of plaque (fat and cholesterol) within the walls of arteries of the brain, much like what occurs in the arteries of the heart leading to heart attacks. In severe cases, ICAD can result in decreased blood flow to the brain, which may cause a stroke.
Risk factors for ICAD include obesity, high blood pressure, high cholesterol, diabetes, smoking, sedentary lifestyle, and certain genetic factors.
Symptoms
Patients with ICAD often do not experience any symptoms until the disease becomes significant enough to result in decreased blood supply to the brain. When this occurs, patients may experience stroke-like symptoms. These symptoms vary depending on which area of the brain is affected, and can include:
- Weakness or paralysis on one side of the body including the arm, leg, and face
- Numbness or a decrease in sensation in these areas
- Vision difficulties
- Difficulty with speech or comprehension
- Difficulty with balance or coordination
- Difficulty swallowing
Diagnosis
Most often, ICAD is identified on CT or MRI scans that are obtained as part of the workup for stroke-like symptoms. In some cases, ICAD may be identified incidentally on imaging studies obtained for unrelated reasons. When ICAD is identified or suspected based on a CT or MRI scan, a cerebral angiogram may be recommended for further evaluation.
Treatment Options
All patients with ICAD should consider lifestyle modification to decrease risk of disease progression and future stroke. This may include careful control of blood pressure and diabetes, quitting smoking, and regular exercise. Medications may also be prescribed to lower stroke risk, including blood pressure medications, aspirin and/or other blood thinners, and cholesterol-lowering medications, such as statins.
In severe cases, procedural interventions such as angioplasty, stent placement, or cranial bypass surgery may be required. These are generally reserved for high-risk patients who do not respond to medical treatment.
How Can We Help You?
The multi-disciplinary team at The Hartford HealthCare Neurovascular Program offers the full spectrum of care for patients with ICAD, from diagnosis, to treatment, to lifelong follow up and support. Our experienced team of specialists includes fellowship-trained neurosurgeons, neuro-interventionalists, vascular neurologists, neuroradiologists, and subspecialized physician assistants, advanced practice registered nurses, and therapists.