Cerebrovascular pathologies in modern medicine represent a significant proportion of all ailments. This is a serious disease that involves cardiac and neurological disorders: dysfunction of the heart muscle and decreased elasticity of the vessels affect the brain and, with a high degree of probability, lead to disability and even death.
To avoid such complications, you must pay attention to the disease in advance and be diagnosed for treatment.
What is carotid stenosis?
Carotid stenosis is a disease in which there is a narrowing or complete blockage of this vessel.
The carotid arteries are blood vessels that are located to the right and left of the neck (respectively, right and left carotid arteries) along the respiratory neck and esophagus.
The right carotid artery originates in the brachial trunk and the left in the aortic arch. Both common carotid arteries through the upper opening of the chest pass to the neck in a vertical direction.
The branching is not inherent to the dormant arteries, but at the level of the superior cartilage of the thyroid gland, each of them divides into an internal carotid artery (ICA) and an external carotid artery (AAC).
The task of the external carotid arteries is to supply useful substances to the facial area and internal ones to supply blood to the brain.
The bifurcation is the place where the obstruction of the carotid artery occurs (partial or complete), that is to say, in any place of its narrowing (anastomosis or division in branches). According to cardiac surgeons, a high probability of atherosclerotic pathology and other vessels can be suggested for blockage at the site of the bifurcation.
It is important More than 20% of pathologies of cerebral blood flow occur along with stenosis of the carotid artery (the carotid arteries are carotid arteries).
Its insignificant percentage is asymptomatic, in most cases they are manifested by brain disorders, which entails a risk to the health and life of the patient.
Only early diagnosis can stop pathological processes.
The state of the external branch determines the probability of occurrence and the severity of the ischemia. The causes of carotid stenosis and complete obstruction are diseases of the obliterating form.
- Vascular disease with gradual obliteration (endarteritis)
- Thickening of arterial walls due to deposits of lipids and cholesterol, and the formation of atherosclerotic plaques that cause narrowing and blockage of the arteries (atherosclerosis).
- Non-specific aortoarteritis (aortic arch syndrome, Takayasu’s disease, pulseless disease).
Occlusion of the carotid artery
Predisposing signs of carotid stenosis:
- Addiction to alcohol and nicotine.
- The obesity
- Passive lifestyle
- Other endocrine diseases
- Abnormal location
- Myocardial damage
- Age changes (senile), especially in men.
- Tendency to increase blood pressure.
- Hereditary predisposition: usually manifested by the tortuosity of one or both ICA, the loops and curves of the blood vessels and, therefore, a hemodynamically significant stenosis occurs at an earlier age
- Increase in the amount of cholesterol in the blood.
Classification of carotid stenosis
According to the recommendations of international studies, it is carried out according to the degree of stenosis of this vessel. To perform the analysis, use KTA (computed tomography angiography), which shows the state, structure and development of the pathological processes of the carotid arteries.
The narrowing coefficient is defined as the ratio of the diameter in the occlusion area to the area closest to the normal size.
CTA: computed tomography angiography helps determine the state of the vessels
What is meant by the normal zone:
- The size of the ACI area.
- Location on the bifurcation site.
- The size of the common carotid artery (OCA), which is 2-4 cm below the mouth.
According to this classification, determine the following degree of blockage of the carotid arteries, according to the size of the space in them:
- The small degree (1% – 29%) is asymptomatic, cerebral ischemia is absent, but the signs of stenosis are determined by a special team
- Moderate (30% – 49%): mild narrowing, compensated by lateral or circumferential blood flow
- Pronounced (50% – 69%) – pronounced, clinically detectable
- Subcritical (70% – 79%) – high risk of circulatory disorders
- The critical clearance (80% – 99%) is reduced to the degree of threat to life:
- More than 99%: complete vessel stenosis occurs.
If atherosclerosis has become the cause of carotid artery stenosis, it is classified according to the following characteristics:
- By type of sediment – homogeneous and heterogeneous plates.
- By prevalence – local or focal type – up to 15 mm, elongated plates – greater than 15 mm
- By type – segmental, semi-concentric, concentric
- In shape – soft and uneven.
- According to the complexity of the pathologies: without complications, with ulceration, hemorrhage, blood clot in the light.
The pathogenesis of carotid stenosis is:
- Hemodynamics– the vascular brain narrows so much that it receives less than ополуч the necessary volume of blood
- Microembolic – intravascular substrates (emboli) with calcium oxalate crystals are separated from the accumulations of cholesterol and begin their movement towards the smaller vessels of the eye and brain, creating clogging and causing cortical cerebral infarction
- Thrombotic– the stenosis enters the complete occlusion of the vessels, causing an extensive heart attack in the area of the middle cerebral artery. The most vulnerable in this sense is the bifurcation region and the initial sections of the common carotid artery.
Symptoms of carotid stenosis
In the initial stage of vascular blockade, the problem is not visible, it is almost asymptomatic, without causing hemodynamically significant disorders.
But when it progresses, and the carotid artery does not deal with the supply of the necessary amount of blood to the brain, it is reflected in the form of cerebral ischemia and neurological manifestations, similar to the signs of a stroke, since there are no specific symptoms of this disease.
Then, the situation worsens: TIA (transient ischemic attacks) are triggered, they are transient and disappear completely in 24 hours.
They are characterized by the following symptoms:
- Sudden dizziness, vestibular ataxia: disorientation in space, difficulty moving.
- Frequent headaches in the back of the head.
- Unreasonable transient faint
- Visual impairment, “blind” on the right or left side of the eye, transient blindness of one eye
- Drowsiness and fatigue
- Weakness in the extremities
- Nausea with vomiting.
- Transient mental disorders or amnesia.
It is important It must be understood that if the symptoms appear, then it is far from the initial stage. Therefore, treatment should begin immediately.
You can request medical help yourself or ask your family members if you can no longer do it yourself.
It may not be TIA, but to develop chronic cerebral ischemia, during which irreversible processes also occur, such as cerebral atherosclerosis and pre-cerebral arteries, including the carotids. Ischemia of the brain eventually causes people to be disabled or lead to death.
Everything that can be attributed to fatigue or age are actually signs of discircular encephalopathy and symptoms of cervical artery stenosis.
But at the beginning, they can be difficulties of several types, like reduction of the yield, lack of memory, difficulty to concentrate, nervousness, difficulty in the communication.
A high degree of occlusion of the right or left carotid artery (PVA or LVSA) means a violation of a much more complicated transient ischemic attack.
Impressively sized plaques rupture, creating blood clots that block blood flow in the vessel and cause an ischemic stroke (cerebral infarction with cell death) or small particles that flow into smaller vessels and infect a specific part of the brain.
If you have signs of stenosis, you should seek first aid. At the same time, the attending physician will not be able to immediately diagnose the symptoms, which, as already mentioned, are not specific.
For this, a series of studies are carried out, the results of which are used to diagnose and prescribe the treatment.
- Ecg heart
- General analysis of blood and urine.
- Ultrasound of the carotid arteries.
The arterial catheter insertion technique is performed under local anesthesia and allows to collect data on blood pressure and free access to frequent blood samples for subsequent laboratory studies.
Before diagnosis, it is not allowed to consume food and drinks for a minimum of 10 hours. Procedures with water and preparation of the inguinal area for surgery (shaving) are also recommended.
Images and results will provide the necessary information for the therapy.
Treatment of stenosis
Who treats the carotid arteries is determined by the therapist and the neurologist, since the disease is in the union of cardiac and cerebral pathologies.
Which doctor intervenes in the treatment of vascular diseases:
- Neurologist – if necessary brain vessel treatment
- Cardiologist – Arterial and lymphatic system therapy
- Angiologist – specialist in disorders of the arteries and lymphatic system.
- Phlebologist or vascular surgeon – deals with various vascular disorders, performs surgery.
And if the diagnosis confirms the pathological degree of stenosis of the carotid artery, then the treatment is prescribed, which can be medical and operative.
Conventional treatment with a drug narrowing of the carotid arteries may be acceptable if the blood flow to the cerebral vessels moves relatively normally, and the stenosis is not critical.