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Carotid Artery Disease

What is carotid artery disease?cad_anatomy

Carotid word comes from Greek and means “to numb”, which should not surprise us, if we think that the pressure applied to the carotid arteries (neck strangulation) causes rapid unconscious of the victim. Carotid artery disease is a serious health problem because it can cause stroke (CVA).

The brain receives blood with oxygen and nutrients through four arteries: two carotid arteries and two vertebral arteries. Carotid atherosclerosis (carotid artery disease) occurs when the arteries become thickened with cholesterol and calcium deposits, being 3rd in frequency after the coronary arteries and the lower limb. These plaques of atherosclerosis narrow the arteries and severe slows down the blood flow to the brain or can broke, so that pieces of it will block the finer blood vessels in the brain. In both cases, the brain does not receive enough blood which causes stroke with paralysis of half the body and face or death. Nearly one quarter of strokes is due to narrowing of the carotid arteries as well.


How to exhibit carotid artery disease?

Unfortunately, in our country, the most common way to detect carotid disease is following a stroke. Analyses made after its production will show narrowing (stenosis) or blockage (occlusion) of the carotid arteries.

Three quarters of these patients who suffer a stroke due to carotid arteries have before cautionary signs as transient ischemic attack (TIA). A TIA is a temporary disturbance of brain function and small amplitude: weakness, numbness of the face or limbs, difficulty in speech or sight (colored dots or black, short moments of blindness or low vision in gray). These disturbances lasting less than 24 hours after the patient recovers fully.



One third of patients who undergo a TIA will have a serious stroke, permanent.

If carotid artery disease produces no symptoms before being detected, it is considered asymptomatic. However, the blood flow through a narrowed artery produces a sound called murmur that can be heard with a stethoscope placed on the neck and that will cause the physician to indicate an imaging test of the carotid arteries.


What risks does carotid artery disease have?

It lies within our grasp to change the so-called risk factors, which are known for the fact that can favor the occurrence of a stroke: arterial hypertension, smoking, obesity and hypercholesterolemia.

Arterial hypertension is the most common and at the urge to treat the risk factor of stroke. Blood pressure should be maintained below 140/90 mm Hg (130/80 in patients with diabetes). One study showed that lowering blood pressure with only 6 mm Hg reduces the risk of a stroke by 42%!

Smoking doubles the chance of a stroke, the risk is increased with the number of cigarettes smoked. If a person has smoked but quit, the risk of developing a stroke in the future is reduced. Smoking also causes narrowing of the carotid arteries after the surgery to remove the obstacle, so it is very important for the patient to quit smoking permanently, especially after surgery.

Obese people have higher chance of having hypertension and hypercholesterolemia, which increases the risk of stroke. It was observed that weight gains of 6-12 kg over a period of 16 years can double the chance of making a stroke.

Maintaining blood fats, especially cholesterol below 200 mg% and a faction called LDL cholesterol below 100 mg% will cause a 30% reduction in stroke, compared to people with high cholesterol. Also, high cholesterol is a cause of blockage of the carotid arteries again after surgery.

Removing these risk factors will require lifestyle changes, often a very difficult thing. Remember that your (family, neurologist, cardiologist or surgeon) doctor can help a lot! Follow the advice and treatment given, do exercise regularly and eat healthy and you can drop more than 10 times the risk of stroke in the future!


What should I do?

If you have one or more of the risk factors listed or have had symptoms already mentioned, contact your cardiologist or surgeon. This will ask questions about your lifestyle, about possible and had had symptoms and will examine you – he will listen for murmurs of the carotid arteries, your blood pressure. If the carotid narrowing is suspected, you will be doing a carotid Doppler examination, which shows with great precision how open are the carotid arteries and how fast blood flows through them. Most experts recommend surgery to remove the atheroma plaque, if the carotid artery narrows by 60% or more.

Usually this test is sufficient, but sometimes the doctor needs more information, so will indicate additional imaging (angiography classical CT angiography or MR angiography with three-dimensional reconstruction) for determining the indication of treatment.


When and how they treat me?

The treatment of carotid stenosis differs by how advanced the disease is as follows:

–        If the carotid artery is narrowed below 60% and did not cause symptoms, it should be treated medically: diabetes should be monitored and blood sugar regulated, blood pressure should be treated with medication to lower it down to normal levels, should be obliged to quit smoking, cholesterol levels should be treated and checked regularly to ensure they are at normal level. Your doctor will probably prescribe other medications like aspirin in low doses.

–        If the carotid artery is narrowed 60% or more and did not cause symptoms, it is advisable to be operated. Obviously, the patient does not have to suffer another serious disease that prohibits operation.

–        If the carotid artery is narrowed more than 60% and caused symptoms such as TIAs, the plaque that is causing stenosis should be surgically removed; otherwise there is a 25% chance in the next two years for the patient to make a permanent stroke.

In what consists the surgical treatment?

The most effective and widespread treatment for carotid disease is to remove plaque that blocks the artery. The surgery is called carotid endarterectomy and can be done in local or general anesthesia. The patient will go home 3 days after surgery. Carotid surgery has evolved tremendously in recent years; its risks are extremely low, even in patients over 75-80 years. The results show that it is a safe and sustainable intervention, significantly to prevent stroke.



Angioplasty and stenting

In some patients, carotid narrowing may be located in a difficult area or the general health state of the patient may make surgery risky. For carotid angioplasty doctor insert a long and fin tube, called a catheter, to the carotid, then another balloon-tipped catheter, which will pressure arterial wall plate, extending vessel. Finally, he will place a thin metal pipe called a stent to keep the carotid open. Because it is a relatively recent technique, results and long-term ability to prevent stroke are still studied.

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