Symptoms, Causes, Diagnosis, and Treatment

Written by WebMD Editorial Contributors

• What Is Atherosclerosis?
• What Causes Atherosclerosis?
• What Are the Symptoms of Atherosclerosis?
• What Are the Risk Factors for Atherosclerosis?
• How Do You Diagnose Atherosclerosis?
• How Does Plaque Affect Atherosclerosis?
• What Are the Complications of Atherosclerosis?
• How Do You Treat Atherosclerosis?
• More

Atherosclerosis is a hardening and narrowing of your arteries caused by cholesterol plaques lining the artery over time. It can put blood flow at risk as your arteries become blocked.

You might hear it called arteriosclerosis or atherosclerotic cardiovascular disease. It’s the usual cause of heart attacks, strokes, and peripheral vascular disease — what together are called cardiovascular disease.

You can prevent and treat this process.

Arteries are blood vessels that carry blood from your heart throughout your body. They’re lined by a thin layer of cells called the endothelium. It keeps the inside of your arteries in shape and smooth, which keeps blood flowing.

Atherosclerosis begins with damage to the endothelium. Common causes include:

• High cholesterol
• High blood pressure
• Inflammation, like from arthritis or lupus
• Obesity or diabetes
• Smoking

That damage causes plaque to build up along the walls of your arteries.

When bad cholesterol, or LDL, crosses a damaged endothelium, it enters the wall of your artery. Your white blood cells stream in to digest the LDL. Over the years, cholesterol and cells become plaque in the wall of your artery.

Plaque creates a bump on your artery wall. As atherosclerosis gets worse, that bump gets bigger. When it gets big enough, it can create a blockage.

That process goes on throughout your entire body. It’s not only your heart at risk. You’re also at risk for stroke and other health problems.

Atherosclerosis usually doesn’t cause symptoms until you’re middle-age or older. As the narrowing becomes severe, it can choke off blood flow and cause pain. Blockages can also rupture suddenly. That causes blood to clot inside an artery at the site of the rupture.

You might not have symptoms until your artery is nearly closed or until you have a heart attack or stroke. Symptoms can also depend on which artery is narrowed or blocked.

Symptoms related to your coronary arteries include:

• Arrhythmia, an unusual heartbeat
• Pain or pressure in your upper body, including your chest, arms, neck, or jaw. This is known as angina.
• Shortness of breath

Symptoms related to the arteries that deliver blood to your brain include:

• Numbness or weakness in your arms or legs
• A hard time speaking or understanding someone who’s talking
• Drooping facial muscles
• Paralysis
• Severe headache
• Trouble seeing in one or both eyes

Symptoms related to the arteries of your arms, legs, and pelvis include:

• Leg pain when walking
• Numbness

Atherosclerosis starts when you’re young. Research has found that even teenagers can have signs.

If you’re 40 and generally healthy, you have about a 50% chance of getting serious atherosclerosis in your lifetime. The risk goes up as you get older. Most adults older than 60 have some atherosclerosis, but most don’t have noticeable symptoms.

These risk factors are behind more than 90% of all heart attacks:

• Abdominal obesity (“spare tire”)
• Diabetes
• High alcohol intake (more than one drink for women, one or two drinks for men, per day)
• High blood pressure
• High cholesterol
• Not eating fruits and vegetables
• Not exercising regularly
• Smoking
• Stress

Rates of death from atherosclerosis have fallen 25% in the past 3 decades. This is because of better lifestyles and improved treatments.

Your doctor will start with a physical exam. They’ll listen to your arteries and check for weak or absent pulses.

You might need tests, including:

• Angiogram, in which your doctor puts dye into your arteries so they’ll be visible on an X-ray
• Ankle-brachial index, a test to compare blood pressures in your lower leg and arm
• Blood tests to look for things that raise your risk of having atherosclerosis, like high cholesterol or blood sugar
• CT scan or magnetic resonance angiography (MRA) to look for hardened or narrowed arteries
• EKG, a record of your heart’s electrical activity
• Stress test, in which you exercise while health care professionals watch your heart rate, blood pressure, and breathing

You might also need to see doctors who specialize in certain parts of your body, like cardiologists or vascular specialists, depending on your condition.

Plaques from atherosclerosis can behave in different ways.

They can stay in your artery wall. There, the plaque grows to a certain size and then stops. Since this plaque doesn’t block blood flow, it may never cause symptoms.

Plaque can grow in a slow, controlled way into the path of blood flow. Over time, it causes significant blockages. Pain in your chest or legs when you exert yourself is the usual symptom.

The worst happens when plaques suddenly rupture, allowing blood to clot inside an artery. In your brain, this causes a stroke; in your heart, a heart attack.

The plaques of atherosclerosis cause the three main kinds of cardiovascular disease:

• Coronary artery disease: Stable plaques in your heart’s arteries cause angina (chest pain). Sudden plaque rupture and clotting cause heart muscle to die. This is a heart attack.
• Cerebrovascular disease: Ruptured plaques in your brain’s arteries cause strokes with the potential for permanent brain damage. Temporary blockages in your artery can also cause something called transient ischemic attacks (TIAs), which are warning signs of a stroke. They don’t cause any brain injury.
• Peripheral artery disease: When the arteries in your legs narrow, it can lead to poor circulation. This makes it painful for you to walk. Wounds also won’t heal as well. If you have a severe form of the disease, you might need to have a limb removed (amputation).

Complications of atherosclerosis include:

• Aneurysms
• Angina
• Chronic kidney disease
• Coronary or carotid heart disease
• Heart attack
• Heart failure
• Peripheral artery disease
• Stroke
• Unusual heart rhythms

Once you have a blockage, it’s generally there to stay. But with medication and lifestyle changes, you can slow or stop plaques. They may even shrink slightly with aggressive treatment.

Lifestyle changes: You can slow or stop atherosclerosis by taking care of the risk factors. That means a healthy diet, exercise, and no smoking. These changes won’t remove blockages, but they’re proven to lower the risk of heart attacks and strokes.

Medication: Drugs for high cholesterol and high blood pressure will slow and may even halt atherosclerosis. They lower your risk of heart attack and stroke.

Your doctor can use more invasive techniques to open blockages from atherosclerosis or go around them:

• Angiography and stenting: Your doctor puts a thin tube into an artery in your leg or arm to get to diseased arteries. Blockages are visible on a live X-ray screen. Angioplasty (using a catheter with a balloon tip) and stenting can often open a blocked artery. Stenting helps ease symptoms, but it does not prevent heart attacks.
• Bypass surgery: Your doctor takes a healthy blood vessel, often from your leg or chest, and uses it to go around a blocked segment.
• Endarterectomy: Your doctor goes into the arteries in your neck to remove plaque and restore blood flow. They also may place a stent higher risk patients.
• Fibrinolytic therapy: A drug dissolves a blood clot that’s blocking your artery.

Your doctor will discuss the complications of these procedures with you. 

Top Picks

Symptoms, Causes, Diagnosis, and Treatment

Written by WebMD Editorial Contributors

• What Is Atherosclerosis?
• What Causes Atherosclerosis?
• What Are the Symptoms of Atherosclerosis?
• What Are the Risk Factors for Atherosclerosis?
• How Do You Diagnose Atherosclerosis?
• How Does Plaque Affect Atherosclerosis?
• What Are the Complications of Atherosclerosis?
• How Do You Treat Atherosclerosis?
• More

Atherosclerosis is a hardening and narrowing of your arteries caused by cholesterol plaques lining the artery over time. It can put blood flow at risk as your arteries become blocked.

You might hear it called arteriosclerosis or atherosclerotic cardiovascular disease. It’s the usual cause of heart attacks, strokes, and peripheral vascular disease — what together are called cardiovascular disease.

You can prevent and treat this process.

Arteries are blood vessels that carry blood from your heart throughout your body. They’re lined by a thin layer of cells called the endothelium. It keeps the inside of your arteries in shape and smooth, which keeps blood flowing.

Atherosclerosis begins with damage to the endothelium. Common causes include:

• High cholesterol
• High blood pressure
• Inflammation, like from arthritis or lupus
• Obesity or diabetes
• Smoking

That damage causes plaque to build up along the walls of your arteries.

When bad cholesterol, or LDL, crosses a damaged endothelium, it enters the wall of your artery. Your white blood cells stream in to digest the LDL. Over the years, cholesterol and cells become plaque in the wall of your artery.

Plaque creates a bump on your artery wall. As atherosclerosis gets worse, that bump gets bigger. When it gets big enough, it can create a blockage.

That process goes on throughout your entire body. It’s not only your heart at risk. You’re also at risk for stroke and other health problems.

Atherosclerosis usually doesn’t cause symptoms until you’re middle-age or older. As the narrowing becomes severe, it can choke off blood flow and cause pain. Blockages can also rupture suddenly. That causes blood to clot inside an artery at the site of the rupture.

You might not have symptoms until your artery is nearly closed or until you have a heart attack or stroke. Symptoms can also depend on which artery is narrowed or blocked.

Symptoms related to your coronary arteries include:

• Arrhythmia, an unusual heartbeat
• Pain or pressure in your upper body, including your chest, arms, neck, or jaw. This is known as angina.
• Shortness of breath

Symptoms related to the arteries that deliver blood to your brain include:

• Numbness or weakness in your arms or legs
• A hard time speaking or understanding someone who’s talking
• Drooping facial muscles
• Paralysis
• Severe headache
• Trouble seeing in one or both eyes

Symptoms related to the arteries of your arms, legs, and pelvis include:

• Leg pain when walking
• Numbness

Atherosclerosis starts when you’re young. Research has found that even teenagers can have signs.

If you’re 40 and generally healthy, you have about a 50% chance of getting serious atherosclerosis in your lifetime. The risk goes up as you get older. Most adults older than 60 have some atherosclerosis, but most don’t have noticeable symptoms.

These risk factors are behind more than 90% of all heart attacks:

• Abdominal obesity (“spare tire”)
• Diabetes
• High alcohol intake (more than one drink for women, one or two drinks for men, per day)
• High blood pressure
• High cholesterol
• Not eating fruits and vegetables
• Not exercising regularly
• Smoking
• Stress

Rates of death from atherosclerosis have fallen 25% in the past 3 decades. This is because of better lifestyles and improved treatments.

Your doctor will start with a physical exam. They’ll listen to your arteries and check for weak or absent pulses.

You might need tests, including:

• Angiogram, in which your doctor puts dye into your arteries so they’ll be visible on an X-ray
• Ankle-brachial index, a test to compare blood pressures in your lower leg and arm
• Blood tests to look for things that raise your risk of having atherosclerosis, like high cholesterol or blood sugar
• CT scan or magnetic resonance angiography (MRA) to look for hardened or narrowed arteries
• EKG, a record of your heart’s electrical activity
• Stress test, in which you exercise while health care professionals watch your heart rate, blood pressure, and breathing

You might also need to see doctors who specialize in certain parts of your body, like cardiologists or vascular specialists, depending on your condition.

Plaques from atherosclerosis can behave in different ways.

They can stay in your artery wall. There, the plaque grows to a certain size and then stops. Since this plaque doesn’t block blood flow, it may never cause symptoms.

Plaque can grow in a slow, controlled way into the path of blood flow. Over time, it causes significant blockages. Pain in your chest or legs when you exert yourself is the usual symptom.

The worst happens when plaques suddenly rupture, allowing blood to clot inside an artery. In your brain, this causes a stroke; in your heart, a heart attack.

The plaques of atherosclerosis cause the three main kinds of cardiovascular disease:

• Coronary artery disease: Stable plaques in your heart’s arteries cause angina (chest pain). Sudden plaque rupture and clotting cause heart muscle to die. This is a heart attack.
• Cerebrovascular disease: Ruptured plaques in your brain’s arteries cause strokes with the potential for permanent brain damage. Temporary blockages in your artery can also cause something called transient ischemic attacks (TIAs), which are warning signs of a stroke. They don’t cause any brain injury.
• Peripheral artery disease: When the arteries in your legs narrow, it can lead to poor circulation. This makes it painful for you to walk. Wounds also won’t heal as well. If you have a severe form of the disease, you might need to have a limb removed (amputation).

Complications of atherosclerosis include:

• Aneurysms
• Angina
• Chronic kidney disease
• Coronary or carotid heart disease
• Heart attack
• Heart failure
• Peripheral artery disease
• Stroke
• Unusual heart rhythms

Once you have a blockage, it’s generally there to stay. But with medication and lifestyle changes, you can slow or stop plaques. They may even shrink slightly with aggressive treatment.

Lifestyle changes: You can slow or stop atherosclerosis by taking care of the risk factors. That means a healthy diet, exercise, and no smoking. These changes won’t remove blockages, but they’re proven to lower the risk of heart attacks and strokes.

Medication: Drugs for high cholesterol and high blood pressure will slow and may even halt atherosclerosis. They lower your risk of heart attack and stroke.

Your doctor can use more invasive techniques to open blockages from atherosclerosis or go around them:

• Angiography and stenting: Your doctor puts a thin tube into an artery in your leg or arm to get to diseased arteries. Blockages are visible on a live X-ray screen. Angioplasty (using a catheter with a balloon tip) and stenting can often open a blocked artery. Stenting helps ease symptoms, but it does not prevent heart attacks.
• Bypass surgery: Your doctor takes a healthy blood vessel, often from your leg or chest, and uses it to go around a blocked segment.
• Endarterectomy: Your doctor goes into the arteries in your neck to remove plaque and restore blood flow. They also may place a stent higher risk patients.
• Fibrinolytic therapy: A drug dissolves a blood clot that’s blocking your artery.

Your doctor will discuss the complications of these procedures with you. 

Top Picks

clinical case, patient history of the clinic JSC “Medicina” in Moscow

Cardiologist

Sokolov

Denis Vladimirovich

Experience 18 years

Cardiologist of the first category, Ph. D., member of the Asute Cardiovascular Care Association (ASSA)

Make an appointment

Analysis of a clinical case presented by Denis Vladimirovich Sokolov, Ph.D., cardiologist at JSC “Medicina” (clinic of Academician Roitberg)

Patient R., 73 years old.

Complaints

Complaints of recurrent pain in the region of the heart of a compressive nature, lasting up to 10-15 minutes, without irradiation, without connection with physical activity. He does not use nitropreparations.

Medical history

She has been observed in the clinic of JSC “Medicina” since 2000. History of hypertension with maximum blood pressure up to 160/100 mm Hg. Art. Episodic pains in the region of the heart of a compressive character, lasting up to 10-15 minutes, without irradiation and without connection with physical activity (did not use nitro drugs). There are no indications of myocardial infarction, acute cerebrovascular accident. Previously, she took concor – 2. 5 mg in the morning, thromboass – 100 mg in the evening, torvacard – 10 mg at night.

For more than 20 years, he has been observed and treated for chronic pyelonephritis.

Past injuries and surgeries, chronic diseases

In 1989 – a car polytrauma with damage to the chest, skull bones, face (operated).

Chronic obstructive pulmonary disease.

Chronic pyelonephritis, cysts of both kidneys.

Rheumatoid arthritis, seronegative polyarthritis, secondary coxarthrosis with aseptic necrosis of the head of the left femur.

Peptic ulcer of the duodenum, persistent remission.

Labor history: artistic director, denies occupational hazards.

Smoking: currently non-smoker, formerly long-term smoker.

The results of examinations in the clinic “Medicine”

Clinical blood test dated 08/06/2011 – mild normochromic anemia.

Clinical analysis of urine dated 08/06/2011 – without significant deviations.

B / x blood tests from 08/06/2011: dyslipidemia type II A (LDL level 3.8 mmol/l, HDL level 1.4 mmol/l), increased urea level up to 8.7 mmol/l, creatinine up to 121 mmol/l l (glomerular filtration rate according to CKD-EPI 38.2 ml / min / 1.73 m ² ), a decrease in the level of ionized calcium to 1.37 mmol / l.

ECG from 07/19/2011 – sinus rhythm, normosystole, deviation of the electrical axis of the heart to the left.

Echocardiography from 1907/07/2011 – sclerotic changes in the aorta, aortic valve with the formation of unexpressed aortic stenosis and aortic insufficiency, wall thickness and size of the heart chambers are normal, diastolic dysfunction of the left ventricle.

24-hour ECG monitoring from 07/22/2011 – single supraventricular and ventricular extrasystole, against the background of persistent horizontal ST-T wave depression on channel 2 from -0.3 to -0.9 mm, 2 episodes of an increase in depression to -1.2-1.9 were noted mm at 21:42 and 12:05, lasting 20-30 minutes, without clinical manifestations and connection with physical activity.

MSCT of the coronary arteries dated 08.2010

The LCA trunk is wide, has smooth contours, and is not stenotic. PNA in the proximal segment has uneven contours due to calcified and partially calcified plaques, the lumen of the artery at this level is narrowed to 30-50%, in the middle segment a number of parietal and circular soft plaques are determined, with arterial stenosis up to 60-75%, distal parts of the artery small caliber, poorly filled with a contrast agent. OA of normal diameter, filled with a contrast agent without signs of hemodynamically significant stenosis. RCA of normal diameter, in the proximal segment there are mixed partially calcified plaques, stenosing the lumen up to 30%, in the middle segment a parietal mixed plaque is visualized, stenosing the lumen up to 50-70%, the distal segment is not changed. Right type of coronary blood supply.

3D reconstruction

Cancer search

On June 28, 2011, for the first time, according to CT of the genitourinary system with intravenous contrast, a CT picture of a tumor formation in the right kidney was revealed, with signs of spread to the perinephric tissue and Gerota’s fascia. Incomplete duplication of the right kidney. Cysts of both kidneys. Body hemangioma L4.

CT scan of the abdominal organs dated 08/06/2011 – CT picture of a cyst in the left lobe of the liver. CT data on secondary lesions of the abdominal organs were not obtained.

MRI of the small pelvis from 08.08.2011 – MRI signs of involutive changes in the pelvic organs with areas of calcification in the projection of the left ovary. Reliable data on the presence of a volumetric formation of the pelvic cavity at the time of the study were not revealed.

Ultrasound of the mammary glands, mammography from 08/06/2011 – fibrocystic involution of the mammary glands.

CT scan of the chest from 08/04/2011 – CT signs of COPD. Diffuse pneumosclerosis. Interstitial and focal changes in both lungs to differentiate between the phenomena of pneumosclerosis and secondary lesions (given the main diagnosis).

Tactics of further management of the patient

The patient has absolute indications for surgery for cancer of the right kidney, but the risk of surgery in conditions of stenosing atherosclerosis of the coronary arteries is extremely high.

At the same time, selective coronary angiography followed by angioplasty and placement of drug-eluting stents would require long-term use of dual antiplatelet therapy (Plavix, acetylsalicylic acid), which would increase the risk of hemorrhagic complications in the conditions of the forthcoming urological operation and in the postoperative period.

Council of 12.08.2011

The patient has several competing diseases:

1. The tumor of the right kidney is determining the prognosis of life. Fuzzy changes in both lungs remain unclear, more on the right. The size of formations does not exceed 5-6 mm; their location, the presence of calcifications and areas of compaction on previous CT scans casts doubt on kidney cancer metastases.

The patient has frequent exacerbations of chronic obstructive pulmonary disease, so they must be differentiated from areas of fibrosis. At the same time, it should be taken into account that even the presence of metastases of minimal size does not exempt from the need for surgery on the right kidney.

2. An aggravating factor is coronary artery disease with stenosis of the coronary arteries, detected according to MSCT data of the coronary arteries. Taking into account the fact that stress-induced myocardial ischemia occurs during ECG Holter monitoring, selective coronary angiography is indicated in the near future. If necessary, non-drug coated stents will be installed, followed by anticoagulant therapy with heparin and the withdrawal of this drug as soon as possible before the next surgical intervention. The choice of this type of stent is due to the possibility of conducting a less intensive regimen of antiplatelet therapy in the conditions of the upcoming nephrectomy operation, as well as in the postoperative period.

Stationary stage of treatment

The patient was hospitalized in the hospital of the clinic “Medicine” on 18.08.2011.

On August 18, 2011, selective coronary angiography was performed.

During the procedure, it was revealed that the trunk of the left coronary artery is usually located. Anterior descending artery – 80% stenosis in the middle third.

The circumflex coronary artery without signs of stenosing atherosclerosis.

The right coronary artery has 70% stenosis in the middle third. Right type of coronary circulation.

Anterior interventricular artery

Right coronary artery

Angioplasty and stenting of the coronary arteries

On August 18, 2011, an interventional cardiac surgeon inserted a balloon catheter with a Multi-link 8 stent 3×12 mm into the area of ​​stenosis of the proximal third of the anterior interventricular artery, and implantation was performed.
A 0.014″ conductor was inserted into the distal part of the right coronary artery. A balloon catheter with a Multi-link 8 stent 3 × 12 mm in size was inserted into the stenosis area, and implantation was performed.

Good blood flow was obtained on control angiograms

In the postoperative period, continuous heparin infusion was performed under the control of APTT, followed by subcutaneous injection of Clexane in therapeutic dosages, followed by cancellation 12 hours before the next surgical treatment.

Taking into account the complete revascularization of the coronary arteries, the patient was prepared for a planned nephrectomy on the right side, and was transferred to a urologist for further supervision.

Surgical stage of hospitalization

On August 22, 2011, as part of the main hospitalization at the Meditsina clinic, the patient underwent laparoscopic radical nephrectomy on the right.

The postoperative period was uneventful; in the early period, anticoagulant therapy with Clexane was performed to prevent thromboembolic complications; continued cardiotropic drugs; prescribed standard antibiotic therapy.

On the second day after surgery, dual antiplatelet therapy was started, including clopidogrel at a dose of 75 mg per day, acetylsalicylic acid at a dose of 100 mg per day.

Against the background of complex therapy, the patient is activated, the postoperative wound healed by primary intention; worsening of coronary heart disease was not observed.

The patient was discharged from the hospital in stable condition on 07.09.2011.

Discharge recommendations:

Bisoprolol 2.5 mg 1 tab. in the morning.

Amlodipine 5 mg ½ tab. In the evening.

Clopidogrel 75 mg 1 tab. in the morning.

Acetylsalicylic acid 100 mg 1 tab. In the evening.

Atorvastatin 20 mg in the evening.

Rabeprazole 20 mg 1 tab. in the morning.

Clinical diagnosis

Cardiac ischemia. Angina pectoris II functional class. Atherosclerosis of the coronary arteries. Angioplasty and stenting of the anterior descending artery with a multi-link 8 drug-free stent measuring 3×12 mm. Angioplasty and stenting of the right coronary artery with a stent without drug coating “Multi-link 8” with dimensions of 3×12 mm from 18.08.2011.
Hypertension stage III. Arterial hypertension II degree. Dyslipidemia II A type. CVE risk 4.

Hypertensive nephropathy. Chronic kidney disease stage 3 B (glomerular filtration rate according to CKD-EPI 38. 2 ml / min / 1.73 m ² ).

Heart rhythm disturbance: ventricular and supraventricular extrasystole. Circulatory insufficiency stage I.

Cancer of the right kidney T1N0M0G1. Laparoscopic nephrectomy on the right from 22.08.2011. Chronic pyelonephritis, stage of remission.

Features of the clinical case

A feature of the tactics of managing this patient was the continuity between interventional methods for the treatment of stenosing atherosclerosis of the coronary arteries and right-sided nephrectomy for cancer performed within the same hospitalization.

Vertebral artery syndrome – treatment, symptoms, causes, diagnosis

Vertebral (vertebral) artery syndrome is the definition of a group of syndromes (vascular, vegetative) arising from impaired blood flow in the vertebral arteries caused by various problems. The main etiological causes of the development of vertebral artery syndrome are the following diseases.

• Vascular diseases with impaired vascular patency, such as atherosclerosis, various embolism arthritis.
• Changes in the shape of the arteries (deformities) – abnormal tortuosity, significant kinks, abnormal structural changes in the arteries.
• Extravasal vascular compression (compression of arteries by osteophytes, hernias, disc protrusions, compression by bone anomalies, tumors, scar tissue)

Considering that various factors can cause the syndrome, it is sometimes difficult to interpret such a diagnosis as vertebral artery syndrome , since this syndrome can be used to designate a variety of conditions, such as acute circulatory disorders, for example. But in clinical practice, degenerative-dystrophic changes in the cervical spine and abnormal phenomena from the atlas, which lead to impaired blood flow in the basin of the vertebral arteries and the appearance of symptoms of cerebrovascular accident, are of the greatest importance.

There are extracranial and intracranial sections of the vertebral artery.

A significant part of the extracranial part of the vertebral arteries pass through a movable canal formed by holes in the transverse processes of the vertebrae. The sympathetic nerve (Frank’s nerve) also passes through this canal. At the C1-C2 level, the vertebral arteries are closed only by soft tissues. This anatomical feature of the passage of the vertebral arteries and the mobility of the cervical region significantly increase the risk of developing a compression effect on the vessels from the surrounding tissues.

The resulting compression from the surrounding tissues leads to compression of the artery of autonomic endings and constriction of blood vessels due to reflex spasm, which leads to insufficient blood supply to the brain.

Degenerative changes in the cervical region (osteochondrosis, arthrosis of the facet joints, uncovertebral arthrosis, instability of motor segments, disc herniation, deforming spondylosis, bone growths (osteophytes), muscle reflex syndromes (inferior oblique muscle syndrome, anterior scalene muscle syndrome) are often cause compression of the vertebral arteries and development of vertebral artery syndrome . Most often, compression occurs at the level of 5-6 vertebrae, a little less often at the level of 4-5 and 6-7 vertebrae. The most common cause of vertebral artery syndrome is uncovertebral syndrome. The close location of these joints to the vertebral arteries leads to the fact that even small exostoses in the region of the uncovertebral joints lead to a mechanical effect on the vertebral arteries. With significant uncovertebral exostoses, significant compression of the lumen of the vertebral arteries is possible.

Quite a significant role in the development of vertebral artery syndrome is played by anomalies of Kimberley, Powers.

Symptoms

According to the clinical course, two stages of the vertebral artery syndrome are distinguished – functional and organic.

The functional stage of the vertebral artery syndrome is characterized by a certain group of symptoms: headaches with some autonomic disorders, cochleovestibular and visual disorders. Headache can have various forms, both acute throbbing, and aching constant or sharply intensifying, especially when turning the head or prolonged static load. The headache may radiate from the back of the head to the forehead. Disturbances in the cochleovestibular system can be manifested by dizziness of a paroxysmal nature (instability of swaying) or systemic dizziness. In addition, some hearing loss is possible. Violations of the visual plan can be manifested by darkening in the eyes, a feeling of sparks, sand in the eyes.

Prolonged and prolonged episodes of vascular disorders lead to the formation of persistent foci of ischemia in the brain and the development of the second (organic) stage of vertebral artery syndrome . In the organic stage of the syndrome, symptoms of both transient and persistent hemodynamic disorders of the brain appear. Transient hemodynamic disorders are manifested by symptoms such as dizziness, nausea, vomiting, dysarthria. In addition, there are characteristic forms of ischemic attacks that occur during a turn or tilt of the head, in which there may be attacks of falling with preserved consciousness, the so-called drop attacks, as well as seizures with loss of consciousness lasting up to 10 minutes (syncope episodes). Symptoms tend to regress with recumbency and are thought to be due to transient brainstem ischemia. After such episodes, general weakness, tinnitus, and autonomic disturbances may be observed.

According to the type of hemodynamic disorders, there are several variants of the vertebral artery syndrome (compression, irritative, angiospathic and mixed forms).

The narrowing of the vessel in the compression version occurs due to mechanical compression on the artery wall. With the irritative type, the syndrome develops as a result of reflex spasm of the vessel due to irritation of the sympathetic fibers. In the clinic, most often, there are combined (compression-irritative) variants of the vertebral artery syndrome. In the angiospastic variant of the syndrome, there is also a reflex mechanism, but it arises from irritation of receptors in the region of the motor segments of the cervical spine. In the angiospastic variant, vegetative-vascular disorders predominate and the symptoms are not so strongly associated with head turns.

Clinical types of the syndrome

Posterior cervical sympathetic syndrome (Barré-Lieu)

Posterior cervical syndrome is characterized by headaches localized in the cervical-occipital region with irradiation to the anterior part of the head. Headache, as a rule, is often constant in the morning, especially after sleeping on an uncomfortable pillow. Headache may occur when walking, driving a car, when moving in the neck. Headache can also be pulsating, piercing with localization in the cervical-occipital region and radiating to the parietal frontal and temporal zones. Headache can be aggravated by turning the head and is accompanied by both vestibular and visual and vegetative disorders.

Basilar migraine

Basilar migraine does not result from compression of the vertebral artery, but due to stenosis of the vertebral artery, but clinically has much in common with other forms of vertebral artery syndrome. As a rule, a migraine attack begins with a sharp headache in the back of the head, vomiting, sometimes with loss of consciousness. Visual disturbances, dizziness, dysarthria, ataxia are also possible.

Vestibulo-cochlear syndrome

Hearing impairments are manifested as noise in the head, decreased perception of whispered speech and are fixed by changes in audiometry data. The tinnitus has a persistent and continuous character and a tendency to change character with head movement. Cochlear disorders are associated with dizziness (both systemic and non-systemic).

Ophthalmic syndrome

In ophthalmic syndrome, visual disturbances such as atrial scotoma, vision loss, photopsy may also be symptoms of conjunctivitis (lacrimation of conjunctival hyperemia). Loss of visual fields can be episodic and is mainly associated with a change in the position of the head.

Syndrome of autonomic changes

As a rule, autonomic disorders do not appear in isolation, but are combined with one of the syndromes. Vegetative symptoms, as a rule, are as follows: a feeling of heat, a feeling of cold extremities, sweating, changes in skin dermographism, sleep disturbances.

Transient (transient) ischemic attacks

Ischemic attacks may occur during the ischemic stage of the vertebral artery syndrome. The most common symptoms of such attacks are: transient motor and sensory disturbances, visual disturbances, hemianopsia, ataxia, dizzy spells, nausea, vomiting, impaired speech, swallowing, double vision.

Syncope vertebral syndrome (Unterharnsheit Syndrome)

An episode of syncope vertebral syndrome is an acute circulatory disorder in the region of the reticular formation of the brain. This episode is characterized by a short-term loss of consciousness with a sharp turn of the head.

Drop attack episodes

A drop attack episode (fall) is caused by impaired blood circulation in the caudal parts of the brainstem and cerebellum and will clinically manifest as tetraplegia when the head is thrown back. Recovery of motor functions is quite fast.

Diagnosis

Diagnosis of vertebral artery syndrome presents certain difficulties and often there is both overdiagnosis and underdiagnosis of vertebral artery syndrome. Overdiagnosis of the syndrome is often due to insufficient examination of patients, especially in the presence of vestibulo-atactic and / or cochlear syndrome, when the doctor fails to diagnose diseases of the labyrinth.

The diagnosis of vertebral artery syndrome requires the presence of 3 criteria.

1. Presence in the clinic of symptoms of one of 9 clinical variants or a combination of variants
2. Visualization of morphological changes in the cervical spine using MRI or MSCT, which may be the main causes of this syndrome.
3. The presence of changes in blood flow during ultrasound examination when performing functional tests with flexion-extension of the head by rotation of the head.

Treatment

Treatment of vertebral (vertebral) artery syndrome consists of two main areas: improvement of hemodynamics and treatment of diseases that led to compression of the vertebral arteries.

Medical treatment

Anti-inflammatory and decongestant therapy aimed at reducing perivascular edema due to mechanical compression. Drugs that regulate venous outflow (troxerutin, ginkgo biloba, diosmin). NSAIDs (celebrex, lornoxicam, celecoxib)

Vascular therapy is aimed at improving the circulation of the brain, as hemodynamic disturbances occur in 100% of patients with this syndrome. Modern diagnostic methods make it possible to evaluate the effectiveness of treatment with these drugs and the dynamics of blood flow in the vessels of the brain using ultrasound. The following drugs are used for vascular therapy: purine derivatives (trental) vinca derivatives (vincamine, vinpocetine) calcium antagonists (nimodipine) alpha-blockers (nicergoline) instenon sermion.

Neuroprotective therapy

One of the most modern areas of medical treatment is the use of drugs to improve energy processes in the brain, which minimizes neuronal damage due to episodic circulatory disorders. Neuroprotectors include: cholinergic drugs (citicoline, gliatilin), drugs that improve regeneration (actovegin, cerebrolysin), nootropics (piracetam, mexidol), metabolic therapy (mildronate, thiotriazoline, trimetazidine)

Symptomatic therapy includes the use of drugs such as muscle relaxants, anti-migraine drugs, antihistamines, and others.