Cedars-Sinai Neurosurgeons Use Minimally Invasive, State-of-the-Art Stenting to Restore Blood Flow to the Brain, Preventing a Debilitating Stroke

Sitting in his cardiologist’s office at Cedars-Sinai one Friday afternoon in 2022, Cornelius Albert suddenly was unable to move or speak.

“I had an attack,” said Albert, 76, who runs a court filing service and lives in View Park. “My limbs went limp like a rag doll and my arms were just dangling, my feet were dangling, and the tears were running out of my eyes. And that lasted for about 30 seconds, maybe a minute.” 

It wasn’t his heart that caused the issue, but Albert happened to be in the right place at the right time. After a round of imaging tests, Albert was diagnosed with intracranial atherosclerotic disease (ICAD). A buildup of plaque in the arteries supplying blood to parts of his brain caused his “ministroke,” also known as a transient ischemic attack, or TIA.

By Monday, Albert was having a lifesaving procedure to open the artery and restore blood flow in his brain.

His surgeon, Michael Alexander, MD, vice chair of Neurosurgery and director of the Neurovascular Center and Endovascular Neurosurgery at Cedars-Sinai, said that for patients with ICAD, plaque buildup can narrow the arteries, causing TIAs and temporary symptoms like those Albert experienced. If the narrowing is severe or the artery is completely blocked, the patient can have a more serious stroke and suffer permanent disability or death. 

“As little as four or five years ago, standard treatment for patients with ICAD was to prescribe medications to lower cholesterol and prevent blood clots,” said Alexander. “Mr. Albert was already taking those medications, and they clearly weren’t helping. With a minimally invasive procedure to place a stent and keep his arteries open, we relieved his symptoms and likely saved his life.”

A lifelong runner, Albert made the cardiologist appointment after experiencing two months of symptoms that included dizziness, weakness, loss of balance and hot flashes. The tests ordered by the cardiologist ruled out heart problems, but an imaging test called a magnetic resonance angiogram (MRA) showed an 85% blockage in one of the arteries supplying blood to the parts of his brain responsible for functions such as balance, coordination, breathing and swallowing.

To clear the blockage, Alexander threaded a tiny catheter through an artery in Albert’s groin, up into the blocked artery in his brain. He inflated a balloon to compress the blockage against the arterial wall, and then put a small tube called a stent in place to hold the artery open.

Results of two multicenter studies led by Cedars-Sinai, published in 2019 and 2021, concluded that this procedure, called intracranial stenting, safely and successfully reduced the incidence of future strokes in patients like Albert.

“Those studies changed how we’re treating ICAD patients today compared with just three years ago,” Alexander said. “Because the results were so positive, the American Stroke Association updated its treatment guidelines to recommend stenting as the best alternative treatment for patients who are having recurrent symptoms, even when they're on medications to prevent blood clots and lower cholesterol.”

Albert, who had been forced to give up driving because of his symptoms, said that recovery from the procedure was a matter of days, and that he is back behind the wheel.

“It felt like a miracle,” Albert said. “Six months after I left the hospital, they did an angiogram and told me that everything is great. The artery is 85% to 90% open. Those attacks were a real scary part in my life and having this procedure was a real blessing.”

Alexander said early ICAD diagnosis is key to preventing a disabling stroke, and that symptoms such as dizziness, double vision or temporary weakness are warning signs that a person should get a medical evaluation.

MRA imaging, which is similar to magnetic resonance imaging (MRI), helps clinicians evaluate blood flow through the brain’s blood vessels. And a newer tool called high-resolution intracranial vessel wall imaging allows clinicians to look at the artery wall to identify cholesterol plaques blocking the artery, tears in the arterial wall, or inflammation of the blood vessel due to vasculitis. Cedars-Sinai was one of the first medical centers to employ this technology.

For patients with an arterial blockage, stenting can be a life-changing option.

“If Mr. Albert had received the standard treatment offered four or five years ago,” Alexander said, “he might have suffered a major stroke and permanent disability. But because we were able to offer him current state-of-the-art treatment, in just a couple of hours we restored blood flow to his brain, his symptoms resolved, and he is back to his very active life.”