Description of the Disease
Internal carotid arteries are located in the neck and are the main blood vessels supplying the brain. Thickening of the artery wall due to atherosclerosis is called plaques. Progression of plaque growth leads to gradual narrowing - stenosis of the internal carotid artery.
Causes of the Disease
Atherosclerosis affects the entire arterial system of the human body, has a complex nature, and is based on genetic predispositions to cholesterol metabolism disorders and its deposition in the vessel walls. Most often, the arteries of the heart, legs, and carotid arteries are affected.
When the degree of stenosis of the internal carotid artery exceeds 70% in the plaque area, changes in blood flow occur, leading to destruction of the inner vessel wall and the formation of microthrombi that migrate with the bloodstream to the brain.
These processes cause acute disruption of cerebral circulation, referred to as ischemic stroke. About 3% of the population over 65 years of age have atherosclerosis of the carotid arteries. Vascular atherosclerosis is hereditary, but in addition to this, there are risk factors under which the disease is detected much more often:
Smoking
High blood pressure
High cholesterol levels in the blood
Diabetes
Ischemic heart disease or a history of myocardial infarction
Atherosclerosis of the arteries of the lower extremities
Elevated levels of total cholesterol, LDL, and HDL cholesterol, high atherogenic coefficient
Symptoms of the Disease
Most people with diseases of the carotid arteries, even with very pronounced stenoses, do not experience any sensations or complaints. Plaques are detected during routine examinations by a cardiologist or ophthalmologist, as well as in the event of a stroke.
Very rarely, carotid artery stenosis manifests as constant ringing in the ears or fainting spells. The first sign of carotid artery involvement is often a stroke or transient ischemic attack (TIA).
The main precursors to the development of a major stroke are the so-called transient ischemic attacks (TIAs), with possible transient paralysis of the arms and/or legs (from several minutes to several hours), speech disturbances, transient or suddenly onset blindness in one eye, memory loss, dizziness, fainting.
Diagnostics of the Disease
Triplex scanning of the brachiocephalic arteries allows real-time visualization of the degree of stenosis, assessment of the size and structure of the atherosclerotic plaque, its integrity, and measurement of the velocity of disturbed blood flow in the affected artery.
Multispiral computed tomography angiography provides three-dimensional data on the condition of the examined vessels of the head and neck with a diameter of more than 2 mm.
Direct angiography is an invasive diagnostic method for atherosclerotic lesions of the neck vessels, necessary in case of discrepancies in the degree of stenosis between triplex scanning and tomography, as well as before surgical treatment.
Treatment of the Disease
In the treatment of carotid artery atherosclerosis, the focus is on excluding or controlling risk factors:
1. Smoking cessation
2. Optimal drug therapy - aimed at preventing thrombosis, lowering cholesterol levels, and normalizing blood pressure
If the degree of stenosis of the carotid artery is more than 70%, carotid endarterectomy (removal of plaque from the carotid artery) or stenting (placement of an expanding stent in the narrowed segment) may be required for stroke prevention.
The choice of surgical treatment method is based on comprehensive patient examination and is selected based on many factors, statistical data, recommendations of domestic and foreign professional associations, and aims to ensure the greatest safety of the upcoming treatment.
Prognosis of the Treatment
In cases of detected stenosis of the internal carotid arteries not exceeding 70%, and with properly selected therapy, the probability of ischemic stroke remains low for an indefinitely long time. In most cases, observation and control of concomitant pathology caused by atherosclerosis (e.g., ischemic heart disease) are sufficient.
In cases of carotid artery involvement leading to a stroke, surgical intervention reduces the risk of recurrent acute cerebrovascular events by 3 times. Prophylactic operations in patients without symptoms are justified in cases of stenosis exceeding 70%, with the aim of reducing the risk of stroke.