Cerebrovascular Diseases: Types, Symptoms, Causes and Treatments

Cerebrovascular diseases are life-threatening conditions caused by blockages, narrowing, bleeding, or congenital vascular malformation abnormalities that develop in the circulatory network carrying the oxygen and nutrients required for the brain to function properly. Today, these diseases are treated without the need for open brain surgery through closed (endovascular) methods performed by entering through a needle-sized point in the groin or arm arteries. By advancing through the vessels using thin flexible tubes, clots in blocked areas are physically removed, bulges carrying a risk of bleeding are filled from within and isolated, or narrowed vessel walls are supported with stents. These sutureless and wound-free interventions, developed to protect brain tissue that is extremely sensitive to oxygen deprivation, rapidly eliminate patients’ life-threatening risks while minimizing the possibility of infection and providing a much safer and faster recovery environment.

What Are the Main Types of Cerebrovascular Diseases?

To make these conditions easier to understand, considering them in three main groups facilitates comprehension of the subject. The first group consists of blockages in which blood flow is obstructed. In this condition, which resembles a water pipe becoming calcified and blocked or sediment falling inside and stopping the flow, oxygen cannot reach the brain region supplied by the vessel. The second group consists of hemorrhages. Here, blood leaks into the skull, which is a closed box, or directly into the brain tissue due to weakness or tearing in the vessel wall. The third group consists of congenital or acquired structural abnormalities. These conditions, in which abnormal connections that should not normally exist are found between arteries and veins, create a type of short circuit in the architecture of the vascular network. All three groups are conditions that must be approached seriously because they disrupt the brain’s nutritional and oxygenation balance.

Which Risk Factors Play a Role in the Development of Cerebrovascular Diseases?

The loss of vascular health is generally not caused by a single factor; it develops gradually over time through the combination of many elements. Some of these factors are conditions we cannot influence, such as advancing age or genetic inheritance. However, the vast majority of the factors forming the risk profile are directly connected to our lifestyle choices and can be controlled. The conditions underlying these diseases and increasing the risk of their development include:

• Advanced age
• High blood pressure
• Diabetes
• High cholesterol
• Smoking
• Excess weight
• Sedentary lifestyle
• Heart rhythm disorders
• Genetic predisposition

Which Symptoms Do Cerebrovascular Diseases Cause in the Body?

Because the brain is a vast control center, the complaints that arise also vary greatly according to the region supplied by the damaged vessel. For example, if there is a problem in a vessel supplying the speech center, the person may be unable to organize words, while a problem affecting the balance center may cause sudden falls. Sometimes these complaints appear suddenly, almost like a power outage, while at other times they may present with mild signs lasting for days. The main symptoms frequently encountered in such situations and requiring attention are as follows:

• Severe headache
• Speech disorder
• Difficulty understanding
• Weakness in the arm
• Numbness in the leg
• Facial drooping
• Vision loss
• Double vision
• Loss of balance
• Dizziness
• Difficulty swallowing
• Confusion

Which Imaging Methods Are Used in the Diagnosis of Cerebrovascular Diseases?

Before deciding on any intervention, it is extremely important to see where the problem is located and how extensive it is. When a patient presents to the hospital, the first method generally used is Computed Tomography (CT) scanning. Tomography is completed within seconds and quickly reveals whether a new hemorrhage has developed in the brain, in particular. When more detailed information is needed, Magnetic Resonance (MR) imaging, which allows tissues to be examined much more precisely, is used. MR provides physicians with significant benefits in detailing a newly developed state of oxygen deprivation or the fine characteristics of the vessels themselves. In addition, Ultrasonography (Doppler) devices that operate with sound waves are frequently used to check the condition of the vessels in the neck region and whether narrowing or calcification is present.

How Is Catheter Angiography Performed in the Diagnosis of Cerebrovascular Diseases?

The method considered the gold standard in imaging technologies is digital angiography, commonly known as angiography. This procedure resembles creating a highly detailed map of the vascular network inside the brain. A small entry is generally made into an artery in the groin or wrist region after applying local anesthesia. Through this entry, thin, plastic, and extremely flexible tubes (catheters) are advanced in the direction of blood flow from the heart to the neck and brain vessels. Once the target vessel is reached, a medical dye (contrast agent) that provides visibility under X-rays is administered. During this time, patients generally experience a mild sensation of warmth in the head lasting for a few seconds. The device records the movement of the administered dye through the vessels and creates three-dimensional models. In this way, an enlargement, narrowing, or blockage in the vessel can be evaluated with millimetric precision.

What Does Closed and Endovascular Treatment Mean for Cerebrovascular Diseases?

Modern medicine aims to provide the greatest benefit by making the least possible intervention in the patient’s body whenever possible. Closed methods called endovascular, meaning intravascular treatment, are a result of this philosophy. In the past, it was necessary to create a surgical opening in the skull to reach a vessel in the brain, whereas this new method uses the body’s own highways, namely the blood vessels. By entering through a small needle hole in the groin or arm, long and thin materials are used to travel to the deepest regions of the brain. The absence of an incision in the skull, bone removal, or external physical contact with brain tissue means a much less traumatic process for patients. The need for general anesthesia is generally lower, and concerns such as postoperative wound infection are largely eliminated.

What Is an Aneurysm (Bulge), One of the Common Cerebrovascular Diseases?

An aneurysm is a condition in which a weak point in the wall of a brain vessel balloons outward. We can compare this condition to a car tire bulging at a weakened point. Over the years, as blood pressure strikes this weak point, the bulge may enlarge and its wall becomes thinner. If this thinned wall can no longer withstand the pressure and ruptures one day, it may lead to brain hemorrhage, which is a highly dangerous condition. Many people may live without knowing they have an aneurysm because these bulges generally remain silent unless they bleed or place pressure on surrounding tissues. However, when they are found incidentally or reach risky sizes, treatment planning is initiated to reduce the possibility of bleeding.

How Is the Coiling Method Applied in the Treatment of Aneurysm-Related Cerebrovascular Diseases?

When closed aneurysm treatment is planned, one of the most frequently used options is the “coiling” method. Once again, the vessel is entered through the groin or arm, and the exact center of the bulge inside the brain is reached using very thin wires. Then, specially manufactured platinum wires compatible with the human body are gradually delivered into the bulge. These wires accumulate like a bundle inside the bulge and tightly fill its interior. Blood can no longer enter the filled bulge, and the risk of rupture is therefore largely brought under control. If the opening where the bulge joins the vessel, meaning its neck, is wide, the safety of the procedure is increased by using temporarily inflated tiny balloons or flexible stents placed in the vessel wall to prevent the inserted coils from falling into the main vessel.

How Do Flow-Diverting Stents Work in the Treatment of Cerebrovascular Diseases?

Advanced technology products called flow-diverting stents are used particularly in aneurysms that have reached enormous sizes or have very wide necks that make them unsuitable for filling with the conventional coiling method. Compared with standard stents, these stents have a much more densely woven, narrow-pored, yet extremely flexible metal mesh structure. When this tightly woven stent is placed in the section of the vessel where the bulge is located, the speed and amount of blood entering the bulge physically decrease. The blood prefers to continue its course through the inside of the stent. The bulge, which no longer fills with blood, begins to deflate over time, while the blood inside it clots and the structure shrinks. Within months, the vessel’s own cells cover the stent and create a new, healthy, and smooth vessel wall in that area.

Why Does Ischemic Stroke, One of the Cerebrovascular Diseases, Occur?

Ischemic stroke, commonly known as paralysis, develops when one of the main vessels supplying the brain suddenly becomes blocked. This blockage generally occurs in two ways. The first is the rupture of the calcified plaque layer that accumulates over the years in the neck or brain vessels and the clot formed there blocking the vessel. The second is a clot formed in the heart due to causes such as a rhythm disorder being carried by the bloodstream and becoming lodged in a narrow vessel in the brain. From the moment the blockage occurs, oxygen cannot reach the region supplied by that vessel. Brain cells are extremely sensitive to oxygen deprivation and begin to lose their functions very rapidly when they cannot receive nourishment.

What Role Does Mechanical Thrombectomy Play in the Treatment of Emergency Cerebrovascular Diseases Such as Stroke?

Because every minute lost during a stroke means the loss of millions of brain cells, intervention is aimed to be performed as early as possible. Although clot-dissolving medications traditionally administered through a vein are useful in blockages up to a certain size, they may not always be sufficient for large clots blocking the main vessels of the brain. In such cases, a lifesaving procedure called mechanical thrombectomy comes into play. The clot is reached directly by advancing through the vessel. Specially designed stent-shaped retrievers are opened inside the clot, or an attempt is made to physically pull and remove the clot from the vessel using a powerful aspiration device. When the vessel is reopened and blood flow is restored, cells that have begun to suffer damage but have not yet lost their vitality are expected to recover, and significant improvements may be observed in the patient’s paralysis.

How Is Carotid Artery Stenosis Treated Within the Scope of Cerebrovascular Diseases?

The carotid arteries located on both sides of our neck and carrying a very large portion of the blood going to the brain may narrow over time due to deposits of fat, cholesterol, and calcium. When plaques in this narrowed area crack, detached fragments may reach the upper parts of the brain and cause paralysis. To manage this condition, the narrowed section must be opened. Once this narrowing in the neck is reached by entering through the patient’s groin or arm, a very thin umbrella-like filter that allows blood to pass but captures clots is first placed beyond the narrowing. This filter helps prevent fragments from traveling to the brain during the procedure. The narrowed area is then widened with a balloon, and a self-expanding stent is placed in the region to support the vessel in remaining open. At the end of the procedure, the filter is removed together with any possible fragments inside it, completing the process.

What Are Vascular Malformations Known as Congenital Cerebrovascular Diseases?

In a healthy circulatory system, high-pressure blood in the arteries passes through a very fine network called capillaries before entering the veins. The capillaries reduce the pressure and allow the blood to continue its course safely. However, this capillary network is absent in congenital or acquired abnormalities such as Arteriovenous Malformation (AVM) or dural fistulas (DAVF). The high-pressure artery connects directly to the vein, and a weak, complex vascular malformation forms between them. Thin-walled veins struggle to withstand this high pressure and tend to enlarge and rupture over time. If left untreated, these malformations may create a foundation for serious brain hemorrhages in later years.

How Is the Liquid Embolization Method Applied in This Cerebrovascular Disease Approach?

When open surgery is risky in the treatment of vascular malformations, liquid embolization, a closed method, offers a highly valuable option. The specialist physician advances through the vessel and reaches the exact center of the malformation. Medically specialized, biocompatible liquid adhesives (embolic agents) are used to close the problematic short-circuit region. These substances, which travel in liquid form through the catheter, freeze within seconds upon contact with the blood in the problematic area and transform into a sponge-like plastic filling material. This filling blocks the abnormal vascular pathways inside the malformation and redirects blood toward the healthy regions of the brain. In some large malformations, this procedure is applied gradually over several sessions rather than in a single procedure, greatly reducing the risk of bleeding.

How Are Brain Tumors Reduced with Cerebrovascular Disease Methods Before Surgery?

Interventional radiology plays an important role not only in the treatment of vascular pathologies but also in the preparation stage of difficult neurosurgical operations. Some brain tumors or neck masses have an incredibly dense vascular network. When surgeons attempt to remove these masses, they may encounter very severe and difficult-to-control bleeding. To prevent this, the patient is taken to the angiography unit a few days before the main tumor operation. The arteries supplying the tumor are identified one by one, and occlusive particles or medical adhesives are injected into them, largely cutting off the tumor’s supply of nutrients and oxygen. The tumor tissue that can no longer receive nourishment shrinks and softens. Thus, when the surgeon begins the operation, a mass that bleeds much less and can be separated more easily is encountered, the duration of surgery is shortened, and the patient’s operation-related risks may be reduced.

How Does the Recovery Process Progress After Endovascular Treatment of Cerebrovascular Diseases?

One of the most satisfying aspects of treatments performed with closed endovascular methods for patients is that the postoperative process is generally quite comfortable. Because there is no wound, suture, or incision in the skull, stays in intensive care or the hospital are quite short. After the procedure, a small bandage is placed over the entry point in the groin or wrist, and the patient is transferred to the room after resting for a few hours. Blood-thinning medications may be requested for a period to prevent clotting and ensure that the inserted materials adapt to the vessel. Patients can generally leave the hospital on their own feet within one or two days and have the opportunity to return to their loved ones and daily lives.

What Can Be Done to Prevent the Development of Possible Cerebrovascular Diseases?

No matter how great the technological advances in treatment may be, never encountering health problems is always the best scenario. There are small but effective measures we can take in our daily lives to help our vessels withstand the years and preserve their flexibility. The main steps you can take to support a healthy vascular structure include:

• Having blood pressure measured regularly
• Keeping blood sugar balanced
• Keeping cholesterol under control
• Following a Mediterranean-style diet
• Maintaining an active lifestyle
• Avoiding tobacco products
• Limiting alcohol consumption
• Reaching an ideal weight
• Developing ways to cope with stress
• Sleeping regularly and with good quality
• Not neglecting medical checkups

Frequently Asked Questions

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