Intracranial atheromatosis and stroke: A silent risk for the brain

Intracranial atheromatosis is a disease that involves the accumulation of atheroma plaques in the arteries within the skull, reducing or blocking blood flow to the brain. This condition is one of the main causes of stroke, especially in older people or those with cardiovascular risk factors such as hypertension, diabetes and high cholesterol. Given its progressive nature and silent effects, intracranial atheromatosis represents a major challenge in the prevention and treatment of stroke.

What is intracranial atheromatosis?

Intracranial atheromatosis is a form of blood vessel disease that occurs when deposits of cholesterol, fat and other substances (plaques) build up in the arteries within the brain. These plaques harden and narrow the arteries, gradually reducing the flow of blood and oxygen needed for brain cells.

As intracranial atheromatosis progresses, it can lead to a significant reduction in blood flow and, in some cases, cause a complete blockage of the artery, triggering an ischemic stroke. Unlike peripheral atherosclerosis (which mainly affects the arteries of the neck or the heart), intracranial atheromatosis affects the small and medium arteries within the skull, increasing the risk of neurological damage.

How is intracranial atheromatosis related to stroke?

Intracranial atheromatosis is one of the main causes of ischemic strokes, the type of stroke that occurs when an artery becomes blocked and cuts off the supply of oxygen to the brain. The buildup of plaques in the intracranial arteries can lead to two types of problems that trigger a stroke:

1. Arterial narrowing (stenosis): Atheromatosis progressively reduces the space inside the artery, decreasing blood flow and increasing the risk of insufficient flow to the brain.
2. Total occlusion: When a plaque grows large enough or ruptures, it can completely block the artery or release fragments that clog other vessels, creating a complete blockage and causing a stroke.

The lack of oxygen and nutrients in the affected areas of the brain results in the death of brain cells, and depending on the area involved, it can cause severe symptoms such as paralysis, loss of vision, speech disorders, and in extreme cases, lead to death.

Risk factors for intracranial atheromatosis and stroke

Some of the risk factors that contribute to intracranial atheromatosis and increase the likelihood of suffering a stroke include:

• High blood pressure: Elevated pressure damages the arteries and accelerates plaque formation.
• Diabetes: Elevated blood glucose levels contribute to atherosclerosis.
• High cholesterol: The accumulation of cholesterol in the arteries is a main cause of plaque formation.
• Smoking: Smoking damages the arteries and promotes the accumulation of atheromas.
• Family history: People with a family history of stroke or cardiovascular disease have a higher risk of developing intracranial atheromatosis.

Recognizing and managing these factors is key to preventing both the progression of atheromatosis and the risk of a stroke.

Diagnosis of intracranial atheromatosis

The diagnosis of intracranial atheromatosis involves several imaging tests to visualize and assess the condition of the arteries in the brain:

• Magnetic resonance angiography (MRA): Allows the observation of cerebral arteries without the need for radiation or invasive contrast.
• Cerebral angiography: It is the standard procedure to visualize intracranial arteries in detail, although it is more invasive and mainly used in complex cases.
• Computed tomography (CT): It can identify calcified plaques in the arteries, helping to measure the degree of narrowing.
• Transcranial ultrasound: It is a less invasive technique to monitor blood flow in the intracranial arteries.

These tests help doctors determine the extent of intracranial atheromatosis and decide on the most appropriate treatment.

Treatment options for intracranial atheromatosis

The treatment of intracranial atheromatosis is aimed at reducing the risk of a stroke and improving blood flow in the brain. Some treatment options include:

1. Antiplatelet drugs: These medications, such as aspirin, help prevent the formation of clots that can block the arteries.
2. Anticoagulants: In some cases, they are prescribed to reduce the likelihood of a clot, especially if the patient has already had a stroke.
3. Risk factor control: Reducing cholesterol, controlling blood pressure, and quitting smoking are essential changes to prevent the progression of atheromatosis.
4. Surgery or angioplasty: In severe cases, a surgical intervention may be necessary to restore blood flow. Procedures include placing a stent in the affected arteries to keep them open.

Prevention of intracranial atheromatosis and stroke

The prevention of intracranial atheromatosis and therefore of strokes involves adopting lifestyle changes and controlling risk factors. Some preventive recommendations include:

• Healthy diet: Reduce the intake of saturated fats and cholesterol, and increase the consumption of fruits, vegetables, and whole grains.
• Regular exercise: Regular physical activity improves circulation and helps keep weight under control.
• Blood pressure and glucose control: Maintaining healthy blood pressure and controlled glucose levels reduces the risk of atheromatosis.
• Smoking cessation: Quitting smoking improves vascular health and reduces the risk of stroke.

Regular medical follow up is also essential to monitor any sign of atheromatosis in people at high risk.

Conclusion

Intracranial atheromatosis is a condition that increases the risk of strokes due to the accumulation of plaques in the arteries of the brain. This process, which can develop slowly and without visible symptoms, is responsible for many cases of ischemic stroke, affecting the quality of life and neurological health of those who suffer from it.

Understanding the relationship between intracranial atheromatosis and stroke is key to implementing effective prevention, diagnosis, and treatment measures. Controlling risk factors and adopting a healthy lifestyle are actions that can significantly reduce the risk of this disease. Likewise, advances in diagnosis and treatment, such as surgical interventions and antiplatelet medication, offer hope for the control of intracranial atheromatosis and the protection of brain health.

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