Carotid disease is a long-lasting and insidious process that lasts for years before clinical symptoms appear, implies stenotic lesions on carotid bifurcation and / or internal carotid artery in patients without symptomatic brain ischemia.
Atherosclerosis is the most common and most important cause of cardiovascular disease, it is the thickening of the arterial wall that passes into the lumen, filled with yellow granular contents.
Atherosclerosis is a progressive, multifactorial, chronic, inflammatory disease in which there is a disorder of the vascular, immune and metabolic system. This process is characterized by the creation of limited thickening (plaques) in the arterial blood vessel wall. The blisters consist of fat (lipids, cholesterol) tissues and calcium. It is manifested through three stages: in the initial lesion, zones of lipid deposits are formed, which are seen as “fat lines”, which are accumulated macrophages filled with lipids in the blood vessel wall. The deposition process continues and “plaques” are formed. These fibrous plaques are stiff, oval, cupid shaped into the lumen of the artery covered by the fibromuscular cap. A gentle lesion progresses to a stage with a fibrous cap upon which there are ulcerations, these lesions can easily rupture and lead to thrombosis and thromboembolism with the onset of clinical manifestations such as: coronary disease, TIA, stroke. Blood vessel lumen can lead to complete obstruction of <occlusion>, resulting in a cessation of circulation and the occurrence of ischemia.
The main arteries that deliver blood and nourish the brain are carotid and vertebral arteries. Common carotid artery (a.carotis comunis) is a paranitary blood vessel on the right side of the brachiocephalic tree, on the left it is separated directly from the aorta arch. This artery extends upward through the frontal side of the neck and in the height of the upper part of the larynx it is split into two final branches , the inner and outer cartoid artery. The inner cartoid artery (a.carotis internal) extends upward through the front of the neck, side by side, up to the base of the skull, passing through the carotid duct on the temporal bone and entering the central cranial cave, on the base of skull gives it two end sections, the front and middle brain arteries. The inner carotid artery is a key blood vessel that enters the skull and further granulates the blood vessels that nourish the brain tissue. The carotid artery is supplied to the blood of the face, head. The changes in the form of an atherosclerotic plaque initially begin on the carotid branch of a.carotis comunis where the process always the most expressive. Carotid occlusive disease is a long-lasting and progressive process without symptoms, while the atherosclerotic plaque does not obstruct 50-70% lumen of the blood vessel. The first symptoms of the disease in the form of feelings of instability, dizziness, buzzing in the ears, and the sense of collapsing occur as a result of reduced oxygen delivery to the tissue.
Transient ischemic attack (TIA) is a short episode of neurological dysfunction that lasts a few minutes, a maximum of one hour. It is caused by short-term insufficient supply of oxygen and glucose to individual parts of the brain and / or retina of the eye. It may manifest itself with the same symptoms as a true stroke, but for a transient ischemic attack, a sharp reduction in visual acuity is characteristic. Symptoms of stroke announcement are expressed in the form of transient neurological disorders that last for a short time and then spontaneously and completely withdraw.
The disturbances are reflected in the transient weakness of the functions of one side of the body, the legs and the arm. A sensitivity disorder at one or both extremes. There may be a feeling of tightness, seizure, disturbances in the coordination of motion and walking, a few minutes of clumsiness. These symptoms are accompanied by a disorder speech that is not possible or unclear, eye disorder on one eye, when narrowing the field of vision or total darkening (lasts less than 10 minutes). Mental disorders, or disorders of consciousness, also follow this condition. Sudden appearance of vertigo followed by vomiting, as well as headaches in the suppressing part, are part of a variety of symptoms.
Risk factors for the onset of atherosclerotic plaque are:
- Increased cholesterol and triglyceride levels in the blood
- High blood pressure
- Tobacco smoke
- Reduced physical activity
- Positive family anamnesis
- Excessive alcohol intake (one glass of wine per day is permitted)
Modern medicine is based on timely diagnosis and treatment of carotid disease. Color duplex scanning arteries provide accurate insight into the morphology and function of carotid arteries. A completely safe, non-invasive and painless way of diagnosing carotid disease is Color Doppler sonography.It is an ultrasound method that allows the visualization of carotid arteries and its branches, works on the principle of Doppler effect. It provides plaque display, allows to measure plaque size, percentage of blood vessels narrowing, plaque surface buildup, and at the same time provides data on flow rates, haemodynamics of the blood vessel. The invasive diagnostic method is angiography and today in some centers it represents the “gold standard” for the diagnosis of carotid disease. The method besides the benefits also carries risks (hematoma at the puncture site, the formation of pseudoanalysis, contrast allergy, CVI during the procedure). Computerized tomography (CT) and nuclear magnetic resonance of the brain provide the ability to exclude other intracranial disease that could be the cause of neurological problems.
The best way to prevent and alleviate disease progression is a moderate, healthy lifestyle
- Regular control, measurement of blood pressure, maintenance at the limit values (<140/90 mm Hg, or <130/80 mm Hg in diabetics) by changing lifestyle or by medication.
- Regular control of glycemic control in diabetics.
- Dietary diet in the first three months in people with elevated lipid levels, later if cholesterol and triglyceride levels continue to rise, cholesterol lowering drugs (statins) are recommended for people at high risk for atherosclerosis.
- Stop smoking cigarettes.
- Stop taking or minimizing the use of alcohol.
- Regular physical activity is advised (fast walks, cycling, swimming).
- People with enlarged body mass index should decrease their weight.
- Dietetic foods with low salt rate, rich in unsaturated fats, omega 3 fatty acids, fruits and vegetables, blue sea fish, fibers are advised.
- The use of Aspirin 100mg daily reduces the possibility of platelet aggregation.
- Applying Vitamin C and E antioxidant antioxidants – reduces the potential for oxidation of LDL cholesterol.
dr Jelena Nikolić