Cerebrovascular disease refers to conditions that adversely affect blood flow to the brain. This may involve either a blockage of blood flow to the brain or the bursting of a vessel that supplies blood to the brain.
Carotid artery disease, also called carotid artery stenosis or carotid artery occlusive disease, is characterized by the narrowing of the carotid arteries, the main blood vessels for carrying oxygenated blood to the brain. This is most commonly related to atherosclerosis (a build-up of plaque) in the artery. If the narrowing becomes severe enough to block blood flow to the brain, or if a piece of plaque breaks off and obstructs blood flow, a stroke may occur.
An aneurysm is a bulging, weakened area in the wall of a blood vessel, resulting in an abnormal widening or ballooning greater than 50 percent of the vessel's normal diameter. Left untreated, a cerebral aneurysm can rupture and cause potentially life-threatening complications, including a stroke. Our Acute Aortic Rapid Response Team responds immediately to patients on site and is part of our Aortic Disease Center which monitors and manages both patients at risk and post-surgical cases.
The Brigham and Women’s Hospital (BWH) Heart & Vascular Center provides advanced diagnosis and treatment for patients with cerebrovascular disease. State-of-the-art techniques, including endovascular treatment, are available for our patients. As a regional, national, and international referral center, we have broad experience in managing vascular problems, ranging from the most common to the rare and complex. Twenty-four-hour consultation is available for urgent or emergency problems.
Risk factors associated with cerebrovascular disease include:
Head trauma is an additional risk factor for developing a brain aneurysm.
When plaque builds up in the carotid artery, blood flow to the brain may be impaired, increasing a patient’s risk of stroke. A brain aneurysm also increases a patient’s stroke risk. A stroke is damaged brain tissue caused by a vascular problem. There are many potential warning signs for stroke, including:
Other potential warning signs for stroke include blackout spells or severe headaches.
At BWH, our vascular disease specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies.
The presence of a carotid artery narrowing may be suggested by one of the warning signs described above. Many patients, however, will be completely asymptomatic, despite significant narrowing of a carotid artery. In many such patients, a careful physical examination will reveal the presence of an audible bruit (abnormal sound heard through a stethoscope) in the neck, caused by disturbed blood flow through the carotid artery.
When a medical history or physical examination suggests potential carotid artery narrowing, the patient is generally sent for a noninvasive imaging study to evaluate the carotid arteries. These studies may include a duplex ultrasound study or a magnetic resonance angiogram. Both are completely noninvasive and highly accurate tests to determine the presence and extent of carotid artery narrowing. When a carotid artery narrowing of greater than 80 percent is found, consideration for repair of the artery is appropriate.
Patients who have had warning signs for stroke and are found to have significantly narrowed carotid arteries are recommended for artery repair. Asymptomatic patients with severe carotid artery narrowing are selectively recommended for intervention based on their age and overall health status.
Most cerebral aneurysms go undiagnosed until after they have ruptured. In these cases, specialists from our Department of Neurosurgery’s Center for Stroke and Cerebrovascular Diseases will use diagnostic methods to confirm a diagnosis of aneurysm and to help guide treatment. These methods may include one or more of the following tests:
Specialists from the Division of Vascular and Endovascular Surgery develop individualized treatment plans for patients based on:
Vascular specialists also recommend medical treatments for carotid artery disease. Along with a modification of lifestyle risk factors, this may include:
Medication
Surgery
For more severe carotid artery narrowing, there are two options. Currently, most patients are recommended standard open surgical treatment of the carotid narrowing:
A new, catheter-based treatment for carotid artery narrowing, which may be offered to patients on a selective basis, is:
After either standard carotid endarterectomy or balloon stent angioplasty, patients are followed with serial duplex ultrasound studies to monitor the progress of their carotid arteries.
Treatment for a cerebral aneurysm that has not ruptured and emergency treatment for a ruptured cerebral aneurysm are provided by neurosurgical specialists.
The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from Brigham and Women’s main 75 Francis St. entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.
If you are having surgery or a procedure, you will likely be scheduled for a visit to the Watkins Clinic for pre-operative information and tests.
The day of surgery, your care will be provided by surgeons, anesthesiologists and nurses who specialize in surgery for patients with coronary heart disease. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care from an experienced surgical and nursing staff.
During your surgery, family and friends can wait in the Shapiro Family Center. Staff members will provide surgery updates and caregivers who leave the hospital will be contacted by cell phone.
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