Louisville Brain Bypass & Revascularization Center

Our expert vascular neurologists evaluate each patient for any and all risk factors associated with disease progression and – when appropriate – develop a personalized regimen of medication with close appointment follow-up. This includes anti-platelet medication, anti-coagulation (blood thinners), cholesterol and hypertension-modifying medications, along with lifestyle modification.

Most patients will undergo a diagnostic angiogram using wires and catheters, through either the wrist or groin artery, to evaluate the blood vessels of the brain, head and neck. This procedure is performed generally as an outpatient appointment and takes about an hour, with one to four hours of recovery before discharge.

Stents: In some cases of steno-occlusive disorders or carotid or vertebral stenosis, endovascular stenting may be an option to enhance blood flow to the brain. Any stenting requires that the patient take two separate antiplatelet medications (usually aspirin and Plavix) for six months, and a single antiplatelet agent thereafter.

One way to restore blood flow to the brain is to use an artery that normally goes to the scalp and connect it to a brain blood vessel after performing a craniotomy. This procedure is called a “direct bypass.” This procedure requires both the donor scalp blood vessel and recipient brain blood vessel to be of sufficient size. Our center is the only one in the state and one of the few in the region to offer direct bypasses to patients. Patients with this surgery take a full dose of aspirin for approximately one year and then decrease to baby aspirin thereafter.

If the recipient or donor blood vessels are not viable or large enough to perform a direct bypass, we can perform an indirect revascularization procedure where a piece of scalp tissue or meninges is laid on top of the brain after performing craniotomy for blood vessels to grow over time and help flow to the brain.

For carotid stenosis in the neck, oftentimes we can offer surgery to open the carotid artery in the neck and remove the plaque to reduce the risk of having a stroke. For patients with carotid stenosis, each case is different, and our team will discuss the benefits and risks of both using a stent and surgical removal of the plaque.