How a narrowing is formed
At the branching point of the common carotid artery, the blood flow twists, and it is here that lipids are most often deposited. A plaque gradually forms: first soft, with a lipid core, then denser, with calcium. The lumen of the vessel narrows, but something else is more dangerous - rupture of the plaque cover. A blood clot instantly forms on the damaged surface, pieces of which are carried away by the blood flow into the arteries of the brain. Therefore, a loose, unstable plaque with a slight narrowing can be more dangerous than a dense, but pronounced one.
- Lipid deposition in the artery wall
- Plaque growth and lumen narrowing
- Ulceration and rupture of the tire
- Thrombosis on the plaque surface
- Embolism - transfer of a blood clot to the vessels of the brain
- A sharp decrease in blood flow with critical stenosis
Risk factors
Carotid artery stenosis is a manifestation of general atherosclerosis, therefore the risk factors are the same as for coronary heart disease. Most often, narrowing is found in people over 60 years of age, especially in smokers and patients with poorly controlled blood pressure. The presence of plaques in the carotid arteries almost always means that atherosclerosis has affected other vessels: coronary arteries, leg arteries. Therefore, the examination is usually not limited to the neck.
- Smoking is one of the most powerful factors
- Arterial hypertension
- Elevated low-density cholesterol
- Diabetes mellitus
- Age and male gender
- Obesity, inactivity
- History of coronary heart disease or atherosclerosis of the leg arteries
Symptoms and transient ischemic attack
Most stenoses are asymptomatic and are detected during examination or by listening to a murmur over the artery. Stenosis is considered symptomatic if it has already caused a transient ischemic attack or stroke. An attack is the same symptoms of a stroke, but passes within minutes or hours. They cannot be ignored: the risk of a full-fledged stroke is greatest in the coming days after such an episode, and the examination must be carried out urgently.
- Weakness or numbness in the limbs on one side
- Impaired speech and understanding
- Short-term blindness in one eye
- Unsteadiness when walking, double vision
- A murmur over the carotid artery during examination is an indirect sign
Diagnostics
The first and main method is duplex scanning of the brachiocephalic arteries. It is painless, does not require preparation and shows the speed of blood flow, the degree of narrowing, the size and structure of the plaque. To clarify before the intervention, CT angiography or MR angiography of the neck vessels is performed. Measuring intima-media thickness helps assess early wall changes. Be sure to examine the lipid profile, glucose and evaluate the condition of the heart.
- Duplex scanning of the neck arteries
- Measuring the thickness of the intima-media complex
- CT angiography of extracranial arteries
- MR angiography of neck vessels
- Lipidogram, glucose, creatinine
- MRI or CT scan of the brain for previous episodes
Treatment and prevention
The basis of treatment for any degree of narrowing is control of risk factors and drug therapy, which is selected by the doctor: cholesterol-lowering drugs and drugs that prevent the formation of blood clots, as well as normalization of blood pressure and sugar. In case of pronounced narrowing, especially if there has already been an ischemic attack, surgical treatment is discussed: removal of the plaque through an incision in the neck or installation of a stent through a vascular access. The decision is made by the vascular surgeon together with the neurologist based on the degree of stenosis and symptoms.
- Complete smoking cessation
- Lipid-lowering therapy as prescribed by a doctor
- Antithrombotic drugs according to indications
- Monitoring blood pressure and glucose levels
- Mediterranean diet, regular walking
- Carotid endarterectomy
- Carotid artery stenting
- Control ultrasound of neck vessels at the appointed time
