What happens in the vessels
Low-density lipoprotein cholesterol penetrates the artery wall, causing chronic inflammation. A plaque with a lipid core and a fibrous cap gradually forms. The danger is not only the narrowing: an unstable plaque with a thin covering can rupture, a blood clot forms on it, and its fragments clog the small arteries of the brain. Most often, plaques are located at the site of division of the common carotid artery into internal and external.
- Thickening of the intima-media complex is an early sign
- Stenosing atherosclerosis - narrowing of the lumen
- Unstable plaque - risk of thrombosis and embolism
- Occlusion - complete blocking of an artery
- Symptomatic and asymptomatic stenosis
Causes and risk factors
Atherosclerosis develops under the influence of several factors, and the more of them, the faster it progresses. The key factor is elevated LDL cholesterol. High blood pressure, smoking, and diabetes are also important. Hereditary predisposition is manifested by early heart attacks and strokes in relatives, as well as elevated levels of lipoprotein (a), which are determined once in a lifetime.
- Elevated LDL cholesterol and lipoprotein(a)
- Arterial hypertension
- Smoking
- Diabetes mellitus
- Obesity and inactivity
- Early cardiovascular diseases in relatives
Symptoms
As long as the plaque does not cause complications, there are usually no complaints. Noise in the head, headache or weather sensitivity are not signs of atherosclerosis. Manifestations occur with embolism or a significant decrease in blood flow. Short-term blindness in one eye is a characteristic sign of damage to the carotid artery. A transient ischemic attack resolves in minutes or hours, but requires the same urgent care as a stroke. With long-term damage to small vessels, memory and thinking are gradually impaired.
- Transient weakness or numbness of half the body
- Short-term speech impairment
- Transient loss of vision in one eye
- Dizziness with unsteadiness and double vision
- Gradual decline in memory and attention
Diagnostics
The main screening method is duplex scanning of the brachiocephalic arteries: it shows plaques, their structure and the degree of narrowing. Transcranial testing evaluates blood flow within the skull. To clarify, CT or MR angiography is performed before surgery. MRI of the brain reveals previous, including asymptomatic, heart attacks. The lipid spectrum, glucose and glycated hemoglobin determine risk factors, ECG determines rhythm disturbances. Since atherosclerosis is systemic, the doctor may recommend examination of the vessels of the heart and legs.
- Duplex scanning of neck vessels
- Transcranial Dopplerography
- CT or MR angiography
- MRI of the brain
- Lipid spectrum, lipoprotein (a)
- Glucose, HbA1c, ECG
Treatment and prevention
The basis of treatment is lowering LDL cholesterol with statins, if necessary in combination with other lipid-lowering drugs. For people with atherosclerosis, the target LDL level is very low, usually below 1.4 mmol/L, and is determined by a doctor. Antiplatelet agents are prescribed according to indications, blood pressure and sugar are kept within target limits. For symptomatic carotid artery stenosis of 70% or more, and in some cases 50-69%, the vascular surgeon considers carotid endarterectomy or stenting. Equally important are quitting smoking, regular physical activity, eating vegetables, fish, whole grains and limiting saturated fat.
- Statins - long-term, without self-cancellation
- Antiplatelet agents as prescribed by a doctor
- Blood pressure and sugar control
- Quitting smoking
- Regular walking and weight loss
- Surgery on the carotid artery for severe stenosis
