Severe Cerebrovascular Stenosis: How Serious Is It?

Severe cerebrovascular stenosis is a critical medical condition. Whether the narrowing occurs in the anterior or posterior circulation, or whether it affects extracranial or intracranial vessels, a stenosis of 70% to 99%, as identified by ultrasound or angiography, is classified as severe. This level of narrowing significantly restricts blood flow to the brain and increases the risk of ischemic events.

Symptoms and Risks of Severe Stenosis

Patients with severe stenosis may experience transient ischemic attacks (TIAs), often referred to as mini-strokes. These episodes can cause temporary neurological deficits such as speech impairment or weakness on one side of the body. Although these symptoms typically resolve on their own within a short time, they serve as a warning sign of a potential major stroke.

If left unmanaged, TIAs can progress into full-blown ischemic strokes. Some patients may even develop cerebral infarction directly at the site of the narrowed vessel. Given these risks, individuals diagnosed with severe cerebrovascular stenosis must take the condition seriously and seek prompt medical attention.

Treatment Options for Severe Cerebrovascular Stenosis

Medical Management

In most cases, doctors recommend conservative medical treatment as the first line of defense. This includes the use of antiplatelet medications such as aspirin or clopidogrel to prevent blood clot formation. In some cases, a dual antiplatelet therapy combining aspirin and clopidogrel may be prescribed for enhanced protection. Additionally, statins are often used to lower cholesterol levels and stabilize plaque buildup in the arteries.

Interventional and Surgical Procedures

When medical therapy is insufficient, more aggressive interventions may be necessary. For example, endovascular treatment with stenting can help open up the narrowed vessel and restore proper blood flow. In cases where the stenosis occurs at the beginning of the internal carotid artery—closer to the heart—an alternative option is carotid endarterectomy, a surgical procedure that removes plaque buildup from the affected artery.

Preventing Stroke and Improving Outcomes

The primary goal of treating severe cerebrovascular stenosis is to prevent stroke and reduce the risk of TIA recurrence. Whether through medication, stenting, or surgery, timely and appropriate treatment plays a crucial role in improving patient outcomes and preserving neurological function. Regular follow-up and lifestyle modifications, such as quitting smoking, managing hypertension, and maintaining a healthy diet, are also essential components of long-term care.