Carotid Artery Disease: Symptoms, Causes, Diagnosis, Treatment

Carotid artery disease is also called carotid artery stenosis. The term refers to the narrowing of the carotid arteries. This narrowing is usually caused by the buildup of fatty substances and cholesterol deposits, called plaque. Carotid artery occlusion refers to complete blockage of the artery. When the carotid arteries are obstructed, you are at an increased risk for a stroke, the 5th leading cause of death in the U.S.

What Are the Carotid Arteries?

The carotid arteries are two large blood vessels that supply oxygenated blood to the large, front part of the brain. This is where thinking, speech, personality, and sensory and motor functions reside. You can feel your pulse in the carotid arteries on each side of your neck, right below the angle of the jaw line.

How Does Carotid Artery Disease Happen?

Like the arteries that supply blood to the heart — the coronary arteries — the carotid arteries can also develop atherosclerosis or “hardening of the arteries” on the inside of the vessels.

Over time, the buildup of fatty substances and cholesterol narrows the carotid arteries. This decreases blood flow to the brain and increases the risk of a stroke.

A stroke — sometimes called a “brain attack” — is similar to a heart attack. It occurs when blood flow is cut off from part of the brain. If the lack of blood flow lasts for more than three to six hours, the damage is usually permanent. A stroke can occur if:

• The artery becomes extremely narrowed
• There’s a rupture in an artery to the brain that has atherosclerosis
• A piece of plaque breaks off and travels to the smaller arteries of the brain
• A blood clot forms and obstructs a blood vessel

Strokes can occur as a result of other conditions besides carotid artery disease. For example, sudden bleeding in the brain, called intracerebral hemorrhage, can cause a stroke. Other possible causes include:

What Are the Risk Factors for Carotid Artery Disease?

The risk factors for carotid artery disease are similar to those for other types of heart disease. They include:

Men younger than age 75 have a greater risk than women in the same age group. Women have a greater risk than men older than age 75. People who have coronary artery disease have an increased risk of developing carotid artery disease. Typically, the carotid arteries become diseased a few years later than the coronary arteries.

What Are the Symptoms of Carotid Artery Disease?

You may not have any symptoms of carotid artery disease. Plaque builds up in the carotid arteries over time with no warning signs until you have a transient ischemic attack(TIA) or a stroke.

Signs of a stroke may include:

• Sudden loss of vision, blurred vision, or difficulty in seeing out of one or both eyes
• Weakness, tingling, or numbness on one side of the face, one side of the body, or in one arm or leg
• Sudden difficulty in walking, loss of balance, lack of coordination
• Sudden dizziness and/or confusion
• Difficulty speaking (called aphasia)
• Confusion
• Sudden severe headache
• Problems with memory
• Difficulty swallowing (called dysphagia)

What Is a Transient Ischemic Attack (TIA)?

A TIA occurs when there is low blood flow or a clot briefly blocks an artery that supplies blood to the brain. With a TIA, you may have the same symptoms as you would have for a stroke. But the symptoms only last a few minutes or few hours and then resolve.

A TIA is a medical emergency because it is impossible to predict whether it will progress into a major stroke. If you or someone you know experiences any of the above symptoms, get emergency help. Immediate treatment can save your life and increase your chance of a full recovery.

Findings show that someone who has experienced a TIA is 10 times more likely to suffer a major stroke than a person who has not had a TIA.

How Is Carotid Artery Disease Diagnosed?

There are often no symptoms of carotid artery disease until you have a TIA or stroke. That’s why it’s important to see your doctor regularly for physical exams. Your doctor may listen to the arteries in your neck with a stethoscope. If an abnormal sound, called a bruit, is heard over an artery, it may reflect turbulent blood flow. That could indicate carotid artery disease.

Listening for a bruit in the neck is a simple, safe, and inexpensive way to screen for stenosis (narrowing) of the carotid artery, although it may not detect all blockages. Some experts believe that bruits may be better predictors of atherosclerotic disease rather than risk of stroke. Be sure to let your doctor know if you have had any symptoms, such as those listed above.

Your doctor may also use a test to diagnose carotid artery disease. Possible tests include the following:

• Carotid ultrasound (standard or Doppler). This noninvasive, painless screening test uses high-frequency sound waves to view the carotid arteries. It looks for plaques and blood clots and determines whether the arteries are narrowed or blocked. A Doppler ultrasound shows the movement of blood through the blood vessels. Ultrasound imaging does not use X-rays.
• Magnetic resonance angiography (MRA). This imaging technique uses a powerful magnet to gather accurate information about the brain and arteries. Then a computer uses this information to generate high-resolution images. An MRA can often detect even small strokes in the brain.
• Computerized tomography angiography (CTA). More detailed than an X-ray, a CT uses X-rays and computer technology to produce cross-sectional images of the carotid arteries. Images of the brain can be collected as well. With this imaging test, the scan may reveal areas of damage on the brain. The CT scan uses a low level of radiation.
• Cerebral angiography (carotid angiogram). This procedure is considered the gold standard for imaging the carotid arteries. It is an invasive procedure that lets a doctor see blood flow through the carotid arteries in real time. Cerebral angiography allows the doctor to see narrowing or blockages on a live X-ray screen as contrast dye is injected in the carotid arteries. This procedure provides the best information. It does carry a small risk of serious complications.

What’s the Treatment for Carotid Artery Disease?

To effectively treat carotid artery disease, doctors recommend the following:

• Following recommended lifestyle habits.
• Taking medications as prescribed.
• Considering a procedure to improve blood flow, if your doctor believes it could help reduce your risk of future stroke.

What Are the Recommended Lifestyle Changes for Carotid Artery Disease?

To keep carotid artery disease from progressing, the following lifestyle changes are recommended:

• Quit smoking.
• Control high blood pressure.
• Control diabetes.
• Have regular checkups with your doctor.
• Have your doctor check your cholesterol and get treatment, if necessary.
• Eat a heart-healthy diet.
• Maintain a healthy weight.
• Exercise at least 30 minutes most days of the week.
• Limit alcohol to 1 drink per day for women, 2 for men.

Which Drugs Can Reduce the Risk of Stroke?

Your doctor may recommend antiplatelet medications such as aspirin and clopidogrel (Plavix) to decrease the risk of stroke caused by blood clots. Your doctor may also prescribe medications to lower cholesterol and blood pressure. In some cases, warfarin (Coumadin), a blood thinner, may be prescribed.

What Medical Procedures Treat Carotid Artery Disease?

If there is severe narrowing or blockage in the carotid artery, a procedure can be done to open the artery. This will increase blood flow to the brain to prevent future stroke. Your doctor may suggest either of the following procedures:

• Carotid endarterectomy (CEA). This has been the commonly performed procedure for patients who have carotid atherosclerosis and TIAs or mild strokes. While you’re under general anesthesia, an incision is made in the neck at the location of the blockage. The surgeon isolates the artery and surgically removes the plaque and diseased portions of the artery. Then, the artery is sewn back together to allow improved blood flow to the brain. The risks and benefits of CEA depend on your age, the degree of blockage, and whether you’ve had a stroke or TIA.
• Carotid artery stenting (CAS). Carotid artery stenting (CAS) is a newer treatment option. It’s less invasive than carotid endarterectomy and is performed in a catheterization laboratory. With CAS, a small puncture is made in the groin. A specially designed catheter is threaded to the area of narrowing in the carotid artery. Once in place, a small balloon tip is inflated for a few seconds to open the artery. Then, a stent is placed in the artery and expanded to hold the artery open. A stent is a small tube that acts as a scaffold to provide support inside your artery. The stent is usually made of metal and is permanent. It can also be made of a material that the body absorbs over time. Some stents have medicine that helps keep the artery from getting blocked again. CAS is a newer procedure, and there is still some controversy as to how well it prevents strokes caused by carotid artery disease. Research suggests that the standard CEA may be safer than CAS, which may raise the risk of stroke or death post procedure.

Carotid Artery Disease (Carotid Artery Stenosis): Treatments

Overview

Carotid Disease Overview

What are the carotid arteries?

Arteries carry oxygen-rich blood away from the heart to the head and body. There are two carotid arteries (one on each side of the neck) that supply blood to the brain. The carotid arteries can be felt on each side of the lower neck, immediately below the angle of the jaw.

The carotid arteries supply blood to the large, front part of the brain, where thinking, speech, personality and sensory and motor functions reside.

The vertebral arteries run through the spine and supply blood to the back part of the brain (the brainstem and cerebellum).

What is carotid artery disease?

Carotid artery disease, also called carotid artery stenosis, is the narrowing of the carotid arteries, usually caused by atherosclerosis. Atherosclerosis is the buildup of cholesterol, fat and other substances traveling through the bloodstream, such as inflammatory cells, cellular waste products, proteins and calcium. These substances stick to the blood vessel walls over time as people age, and combine to form a material called plaque.

Plaque buildup can lead to narrowing or blockage in the carotid artery which, when significant, can put an individual at increased risk for stroke.

Symptoms and Causes

What are the symptoms?

There may not be any symptoms of carotid artery disease. However, there are warning signs of a stroke. A transient ischemic attack (also called TIA or “mini-stroke”) is one of the most important warning signs of a stroke. A TIA occurs when a blood clot briefly blocks an artery that supplies blood to the brain. The following symptoms of a TIA, which are temporary and may last a few minutes or a few hours, can occur alone or in combination:

• Sudden loss of vision or blurred vision in one or both eyes
• Weakness and/or numbness on one side of the face, or in one arm or leg, or one side of the body
• Slurred speech, difficulty talking or understanding what others are saying
• Loss of coordination
• Dizziness or confusion
• Difficulty swallowing

A TIA is a medical emergency, since it is impossible to predict if it will progress into a major stroke. If you or someone you know experiences these symptoms, get emergency help (Call 9-1-1 in most areas). Immediate treatment can save your life or increase your chance of a full recovery.

TIAs are strong predictors of future strokes; a person who has experienced a TIA is 10 times more likely to suffer a major stroke than someone who has not experienced a TIA.

What is a stroke?

A stroke, or “brain attack,” occurs when a blood vessel in the brain becomes blocked or bursts. The brain cannot store oxygen, so it relies on a network of blood vessels to provide it with blood that is rich in oxygen. A stroke results in a lack of blood supply, causing surrounding nerve cells to be cut off from their supply of nutrients and oxygen. When tissue is cut off from its supply of oxygen for more than 3 to 4 minutes, it begins to die.

A stroke can occur if:

• The artery becomes extremely narrowed by plaque
• A piece of plaque breaks off and travels to the smaller arteries of the brain
• A blood clot forms and blocks a narrowed artery

A stroke also can occur as a result of other conditions, such as sudden bleeding in the brain (intracerebral hemorrhage), sudden bleeding in the spinal fluid space (subarachnoid hemorrhage), atrial fibrillation, cardiomyopathy, or blockage of the tiny arteries inside the brain.

Diagnosis and Tests

How is carotid artery disease diagnosed?

There may not be any symptoms of carotid artery disease. If you are at risk, it is important to have regular physical exams.

A doctor will listen to the arteries in your neck with a stethoscope. An abnormal rushing sound, called a bruit (pronounced BROO-ee), may indicate carotid artery disease. However, bruits are not always present when there are blockages, and may be heard even when the blockage is minor.

Diagnostic tests include:

• Carotid duplex ultrasound: An imaging procedure that uses high-frequency sound waves to view the carotid arteries to determine if there is narrowing. This is the most common test utilized to evaluate for the presence of carotid artery disease.
• Carotid angiography (carotid angiogram, carotid arteriogram, carotid angio): During this invasive imaging procedure, a catheter (thin, flexible tube) is inserted into a blood vessel in the arm or leg, and guided to the carotid arteries with the aid of a special X-ray machine. Contrast dye is injected through the catheter while X-rays of the carotid arteries are taken. This test may be performed to evaluate or confirm the presence of narrowing or blockage in the carotid arteries, determine the risk for future stroke and evaluate the need for future treatment, such as carotid stenting or surgery.
• Magnetic resonance angiogram (MRA): MRA is a type of magnetic resonance image (MRI) scan that uses a magnetic field and radio waves to provide pictures of the carotid arteries. In many cases, MRA can provide information that cannot be obtained from an X-ray, ultrasound, or computed tomography (CT) scan. This test can provide important information about the carotid and vertebral arteries and the degree of stenosis.
• Computerized tomography (CT Scan): A CT of the brain may be performed if a stroke or TIA is suspected to have already occurred. During a CT scan, X-rays pass through the body and are picked up by detectors in the scanner, which produce three-dimensional (3D) images on a computer screen. Depending on the type of scan you need, a contrast material might be injected intravenously (into a vein) so the radiologist can see the body structures on the CT image. This test may reveal areas of damage in the brain.
• Computed tomography angiogram (CTA): A test that uses advanced CT technology, along with intravenous (IV) contrast material (dye), to obtain high-resolution, 3D pictures of the carotid arteries. CTA images enable physicians to determine the degree of stenosis in the carotid and vertebral arteries and can also assess leading to these arteries as well as the blood vessels in the brain.

Management and Treatment

How is carotid artery disease treated?

Carotid artery disease is treated by:

• Making lifestyle changes
• Taking prescribed medications
• Having procedures as recommended

Lifestyle changes

To prevent carotid artery disease from progressing, these lifestyle changes are recommended by your doctor and the National Stroke Association:

• Quit smoking and using tobacco products.
• Control high blood pressure, cholesterol, diabetes, and heart disease.
• Have regular checkups with your doctor.
• Have your doctor check your lipid profile and get treatment, if necessary to reach a lipid goal of LDL less than 100 and HDL greater than 45 (your doctor may adjust these goals based on additional risk factors and/or medical history).
• Eat foods low in saturated fats, cholesterol, and sodium.
• Achieve and maintain a desirable weight.
• Exercise regularly – at least 30 minutes of exercise most days of the week.
• Limit the amount of alcohol you drink. Excessive alcohol use is defined as drinking more than three drinks per day. (One drink equals 12 ounces of beer or wine cooler, 5 ounces of wine, or 1.5 ounces of 80-proof liquor.)
• Manage other risk factors:

Medications

Anti-platelet medications: All patients with carotid artery disease should take an anti-platelet medication to reduce the risk of stroke and other cardiovascular disease complications. The most commonly used anti-platelet medication is aspirin.

Other drugs that work to keep platelets from “sticking together” include clopidogrel (Plavix) and dipyridamole (Persantine), which may be prescribed alone or in combination with aspirin to reduce your risk of stroke. In some cases, the anticoagulant medication warfarin (Coumadin) may be prescribed to thin your blood and reduce the risk of blood clots.

Tissue plasminogen activator (t-PA): A clot-dissolving medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of strokes caused by blood clots (ischemic strokes). Eighty percent of all strokes are ischemic. T-PA only works if it is given within three hours of the start of stroke symptoms.

Treatment procedures

Carotid Stenting

If there is severe narrowing or blockage in the carotid artery, a procedure may be necessary to open the artery and increase blood flow to the brain, to prevent a future stroke.

If you have symptoms related to carotid artery narrowing, you will likely need to have either carotid endarterectomy or carotid stenting to correct the narrowing in the artery and reduce your risk of stroke. Your vascular specialist will evaluate you to recommend the best treatment for your situation.

If you have carotid narrowing without symptoms, your vascular specialist will evaluate your test results and risk status to make a recommendation as to whether medical therapy, carotid stenting or carotid endarterectomy would be the best option.

Carotid endarterectomy is the traditional surgical treatment for carotid artery disease. Carotid endarterectomy has been proven to be beneficial for symptomatic patients with a 50 percent or greater carotid stenosis (blockage) and for asymptomatic patients with a 60 percent or greater carotid stenosis.

Carotid endarterectomy can be performed under general anesthesia (the patient is asleep) or local anesthesia with intravenous sedation. During the procedure, an incision is made in the neck at the site of the carotid artery blockage. The surgeon removes the plaque from the artery and when the plaque removal is complete, the surgeon stitches the vessel closed. Blood flow to the brain is restored through its normal path.

Carotid angioplasty and stenting has been FDA-approved as a treatment option for some patients with carotid artery disease. Please talk to your doctor to determine if you are eligible.

The carotid angioplasty and stenting procedure is performed while the patient is awake, but sedated. During the procedure, a balloon catheter is inserted through a sheath in a blood vessel. With X-ray guidance, the catheter is placed through the blood vessel and directed to the carotid artery at the site of the blockage or narrowing. A specially designed guidewire with a filter is placed beyond the area of blockage or narrowing.

Once in place, the balloon tip is inflated for a few seconds to open or widen the artery. The filter (called the embolic protection device) collects any debris that may break off of the blockage. A stent (a small mesh tube) is placed in the artery and opens to fit the size of the artery. The stent stays in place permanently and acts as a scaffold to support the artery walls and keep the artery open. After several weeks, the artery heals around the stent.

Research has shown that carotid stenting, when used with the embolic protection device, was as safe and effective as carotid endarterectomy in high-risk surgical patients.Recovery from both the carotid endarterectomy and carotid angioplasty and stenting procedures generally requires a one-night hospital stay. Patients often return to regular activities within one to two weeks after these procedures.

Follow-up care

Your doctor will want to see you on a regular basis for a physical exam and possibly to perform diagnostic tests. Your doctor will use the information gained from these visits to monitor the progress of your treatment. Check with your doctor to find out when to schedule your next appointment.

Prevention

What are the risk factors for carotid artery disease?

The risk factors that have been linked to the development of atherosclerosis include:

• Family history of atherosclerosis (either carotid artery disease or coronary artery disease or elsewhere in the vascular system)
• Age: In general, the risk of atherosclerosis increases as we age, and in particular, men under age 75 have a greater risk of developing carotid artery disease than women, but after age 75, women have a greater risk than men
• High levels of low density lipoprotein (LDL, bad cholesterol) and triglycerides in the blood. However, this link is not as strong as it is for coronary artery disease
• Smoking
• High blood pressure (hypertension)
• Diabetes
• Obesity
• Sedentary lifestyle

Typically, the carotid arteries become diseased a few years later than the coronary arteries. People who have coronary artery disease, and atherosclerosis elsewhere (such as peripheral artery disease or PAD) have a higher risk of developing carotid artery disease.

Resources

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart, Vascular & Thoracic Institute Outcomes.

Cleveland Clinic Heart, Vascular & Thoracic Institute Vascular Medicine Specialists and Surgeons

Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart, Vascular & Thoracic Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:

Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.

Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.

You may also use our MyConsult second opinion consultation using the Internet. The Heart, Vascular & Thoracic Institute also has specialized centers and clinics to treat certain populations of patients:

Learn more about experts who specialize in the diagnosis and treatment of vascular and arterial disease.

See About Us to learn more about the Sydell and Arnold Miller Heart, Vascular & Thoracic Institute.

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If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart, Vascular & Thoracic Institute Resource & Information Nurse at 216. 445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Carotid stenosis, carotid artery disease

Overview

Carotid stenosis is a narrowing of the carotid arteries, the two major arteries that carry oxygen-rich blood from the heart to the brain. Also called carotid artery disease, carotid stenosis is caused by a buildup of plaque (atherosclerosis) inside the artery wall that reduces blood flow to the brain. Treatment aims to reduce the risk of stroke by controlling or removing plaque buildup and preventing blood clots.

Blood supply of the brain

To understand carotid stenosis, it is helpful to understand the circulatory system of the head and neck (see Anatomy of the Brain). The carotid artery begins at the aorta in the chest as the common carotid and courses up through the neck to the head. Place your hands on either side of your neck, and you can feel your pulse in your carotid arteries. Near the larynx, the common carotid divides into the external and internal carotid arteries. The external carotid arteries supply blood to the face and scalp. The internal carotid arteries supply blood to the brain. The most common location of atherosclerotic plaque buildup is the carotid bifurcation (Fig. 1), where the common carotid divides into the internal and external carotid arteries.

Figure 1. The common carotid artery divides into the internal and external carotid arteries. The bifurcation (green circle) is the most common site of plaque buildup.

What is carotid stenosis?

Carotid stenosis is a progressive narrowing of the carotid arteries in a process called atherosclerosis. Normal healthy arteries are flexible and have smooth inner walls. As we age, hypertension and small injuries to the blood vessel wall can allow plaque to build up. Plaque is a sticky substance made of fat, cholesterol, calcium, and other fibrous material. Over time, plaque deposits inside the inner wall of the artery can form a large mass that narrows the lumen, the inside diameter of the artery. Atherosclerosis also causes arteries to become rigid, a process often referred to as “hardening of the arteries.”

Figure 2. A. Atherosclerotic plaque narrows the artery diameter, reducing blood flow.
B. The irregular surface of the artery wall can cause clot formation that blocks the vessel or breaks off, travels downstream, and blocks a smaller vessel.

There are three ways in which carotid stenosis increases the risk of stroke:

• Plaque deposits can grow larger and larger, severely narrowing the artery and reducing blood flow to the brain. Plaque can eventually completely block (occlude) the artery (Fig. 2A).
• Plaque deposits can roughen and deform the artery wall, causing blood clots to form and blocking blood flow to the brain (Fig. 2B).
• Plaque deposits can rupture and break away, traveling downstream to lodge in a smaller artery and block blood flow to the brain.

What are the symptoms?

Most people with carotid stenosis have no symptoms until the artery becomes severely narrowed or a clot forms. Symptoms are most likely to first appear with a mini-stroke, also known as a transient ischemic attack (TIA). TIAs result when blood flow to the brain is temporarily interrupted and then restored. The symptoms typically last a couple of minutes and then resolve completely, and the person returns to normal. TIAs should not be ignored; they are a warning that an ischemic stroke and permanent brain injury may be looming. Symptoms of a TIA or an ischemic stroke can include weakness or numbness in an arm or leg, difficulty speaking, a drooping face, vision problems, or paralysis affecting one side of the body. If you or a loved one develops these symptoms, you should call 911 immediately.

What are the causes?

Atherosclerosis is the major cause of carotid artery disease. It can begin in early adulthood, but it usually takes decades to cause symptoms. Some people have rapidly progressing atherosclerosis during their thirties, others during their fifties or sixties. Atherosclerosis begins with damage to the inner wall of the artery caused by high blood pressure, diabetes, smoking, and high cholesterol –specifically “bad” cholesterol or low-density lipoprotein (LDL). Other risk factors include obesity, coronary artery disease, a family history of carotid stenosis, and advanced age.

Less commonly, carotid aneurysm and fibromuscular dysplasia can cause carotid stenosis.

People who have heart disease have an increased risk of developing carotid stenosis. Typically, the carotid arteries become diseased a few years later than the coronary arteries.

Who is affected?

Older people are more likely to be affected by carotid stenosis. Before age 75, men are more at risk than women. A person who has high cholesterol, has high blood pressure, and smokes is eight times more likely to develop atherosclerosis than a person without these risk factors. More than 500,000 new strokes occur in the United States each year, and carotid stenosis is estimated to cause 20 to 30% of them.

How is a
diagnosis made?

Your doctor will learn as much as possible about your symptoms, current and previous medical problems, current medications, and family history. He or she will perform a physical exam. The doctor may listen to the carotid artery with a stethoscope to detect a swishing noise called a “bruit.” A bruit may be a sign of turbulent blood flow caused by atherosclerosis. One or more diagnostic tests are performed to detect narrowing of the carotid arteries. Carotid stenosis is diagnosed by either a doppler ultrasound of the neck, a CT angiogram (CTA) of the neck, magnetic resonance angiography (MRA), or a cerebral angiogram.

Imaging also can reveal evidence of multiple small strokes. Doctors can make a diagnosis of carotid stenosis if tests show diminished blood flow in one or both carotid arteries. You may be referred to a neurosurgeon for a surgical consultation.

Figure 3. Doppler ultrasound of the carotid artery showing a narrowed artery lumen.

• Doppler ultrasound is a noninvasive test that uses reflected sound waves to evaluate blood flow through a vessel (Fig. 3). The ultrasound probe is placed on the neck over the carotid arteries. This test will reveal how much blood is flowing through the artery and to what degree the artery has narrowed (i.e., 100%, 80%, 70%, etc.).
• Computed Tomography Angiography, or a CT angiogram, is a noninvasive X-ray that provides detailed images of anatomical structures within the brain. It involves injecting a contrast agent into the blood stream so that arteries of the brain can be seen. This type of test provides the best pictures of both blood vessels (through angiography) and soft tissues (through CT). It enables doctors to see the narrowed artery and to determine how much it has narrowed.
• Magnetic Resonance Angiography (MRA) of the neck is similar to the CT angiogram. Contrast dye is injected through an IV to illuminate blood vessels in the neck.
• Cerebral Angiogram is a minimally invasive test that uses X-rays and a contrast agent injected into the arteries through a catheter in the groin. It enables doctors to visualize all arteries in the brain (Fig. 4).

Figure 4. Angiogram of the carotid artery showing a narrowing of the vessel caused by atherosclerotic plaque (red arrow).

What treatments are available?

The goal of treatment is to reduce the risk of stroke. Treatment options vary according to the severity of the arterial narrowing and whether you are experiencing stroke-like symptoms or not.

Medications

People who have no symptoms or who have low-grade carotid stenosis of less than 50% are usually treated with medications [1,3]. People who have a medical condition that would increase the risk of surgery also are likely to be treated with medication. Medications include:

• Antiplatelet medications (aspirin, ticlopidine, clopidogrel) thin the blood and prevent clotting in the narrowed arteries, which allows blood to pass through more easily.
• Cholesterol-lowering statins help reduce plaque formation in atherosclerosis. Statins can reduce LDL “bad” cholesterol by an average of 25-30% when combined with a low-fat, low-cholesterol diet.
• Antihypertensive medications (diuretics, ACE inhibitors, angiotensin blockers, beta blockers, calcium channel blockers, etc.) help control and regulate blood pressure. Because high blood pressure is a major risk of stroke, regular blood pressure screenings are recommended.

Surgery

Surgical treatment is generally recommended for patients who have suffered one or more TIAs or strokes and who have a moderate to high grade of carotid stenosis [2,3]. The aim of surgery is to prevent stroke by removing or reducing the plaque buildup and enlarging the artery lumen to allow more blood flow to the brain.

• Carotid endarterectomy is an open surgery to remove the plaque. A skin incision is made in the neck and the carotid artery is located. Temporary clamps are placed across the artery above and below the area of stenosis to stop blood flow. During this time, the carotid artery on the other side of the neck carries blood flow to the brain. The surgeon makes an incision in the artery over the blocked area. The plaque buildup is peeled out and removed (Fig. 5). The artery is then closed with tiny sutures and the clamps removed to allow blood flow to the brain.

Figure 5. A carotid endarterectomy is a surgery to remove plaque from the area of the carotid artery where the internal and external carotid arteries branch.

Carotid endarterectomy is typically indicated for patients who have had symptoms (stroke or TIA) and have blockage greater than 50%. It is also recommended for patients who have no symptoms and have blockage greater than 60%. Among patients with moderate blockage of 50 to 69%, surgery reduces the risk of stroke by 6.5% over a five-year period. Among patients with high-grade blockage of more than 70%, the risk of stroke is reduced by 80% [2]. The benefit of endarterectomy for patients whose stenosis is 50% or less does not outweigh the risks of the surgery.

• Carotid angioplasty / stenting is a minimally invasive endovascular procedure that compresses the plaque and widens the lumen of the artery. It is performed during an angiogram in a radiology suite. A flexible catheter is inserted in the femoral artery in the groin. It is guided through the blood stream past the heart, and into the carotid artery. Next, a small catheter with an inflatable balloon at the tip is positioned across the plaque (Fig. 6). The balloon is opened to dilate the artery and compress the plaque against the artery wall. The balloon is then deflated and removed. Finally, a self-expanding mesh-like tube called a stent is placed over the plaque, holding open the artery.

  Angioplasty / stenting is typically indicated for select patients who 1) have moderate to high-grade carotid stenosis greater than 70%; 2) have other medical conditions that increase the risk of surgical complications; 3) have recurrent stenosis; or 4) have stenosis that was caused by prior radiation therapy [3].

  Figure 6. During angioplasty, a balloon-tipped catheter is placed within the narrowed vessel. The balloon is inflated compressing the plaque and opening the artery. The balloon is removed and a self-expanding mesh stent is placed over the plaque to hold open the artery. The stent remains in the artery permanently.

• Carotid artery bypass is a surgery that reroutes the blood supply around the plaque-blocked area. A length of artery or vein is harvested from somewhere else in the body, usually the saphenous vein in the leg or the ulnar or radial arteries in the arm. The vessel graft is connected above and below the blockage so that blood flow is rerouted (bypassed) through the graft. Bypass is typically only used when the carotid is 100% blocked (carotid occlusion).

Clinical trials

Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective. Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including eligibility, protocol, and locations, are found on the Web. Studies can be sponsored by the National Institutes of Health (see ClinicalTrials.gov) as well as private industry and pharmaceutical companies (see CenterWatch.com).

Recovery & prevention

Depending on your risk factors, your physician may ask you to stop smoking, limit heavy alcohol consumption, maintain good blood-sugar control (if you have diabetes), have your cholesterol checked regularly, and take medications as prescribed.

It’s important to remember that carotid stenosis is a progressive disease. If left untreated, carotid stenosis has a stroke rate of 13% per year [3] in people with symptoms and 2.2% per year [1] in people without symptoms. Do not ignore the early warning signs!

After carotid endarterectomy, restenosis can occur in less than two years and is usually not symptomatic. These regrown plaques can be treated with angioplasty and stenting. The plaques may regress with time, and intervention is reserved for stenosis greater than 80%. After two years, restenosis is more often related to progression of atherosclerotic disease. In general, repeat surgery or stenting is advised for symptomatic restenosis or stenosis greater than 80%.

Sources &
links

If you have more questions, please contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.

Sources

1. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for Asymptomatic Carotid Artery Stenosis. JAMA 273:1421-28, 1995
2. Barnett HJ, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 339(20):1415-25, 1998
3. Hobson RW 2nd, et al.; Society for Vascular Surgery. Management of atherosclerotic carotid artery disease: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg 48(2):480-6, 2008

Links

StrokeAssociation.org
Vascular.org
AmericanHeart.org

angioplasty: an endovascular procedure with a balloon-tipped catheter to enlarge a narrowing in an artery.

atherosclerosis: a disease of the arterial blood vessels, in which the walls of the arteries become thickened and hardened by plaques. Plaques are composed of cholesterol and other lipids, inflammatory cells, and calcium deposits; also called “hardening of the arteries.”

cholesterol: a fat-like substance that is made by the human body and eaten in animal products. Cholesterol is used to form cell membranes and process hormones and vitamin D. High cholesterol levels contribute to the development of atherosclerosis.

endarterectomy: a surgical procedure in which material occluding the carotid artery is cleaned out, thereby restoring normal blood flow to the brain and preventing a stroke.

fibromuscular dysplasia: abnormal cell growth in the artery walls that causes narrowing and a “string of beads” appearance; usually affects arteries of the kidneys and brain.

hemorrhagic stroke: stroke caused by the rupture of a blood vessel in the brain.

ischemic stroke: a stroke caused by an interruption or blockage of oxygen-rich blood flow to an area of the brain; caused by a blood clot, atherosclerosis, vasospasm, or reduced blood pressure.

LDL cholesterol: Low-density lipoprotein cholesterol is the primary cholesterol molecule. High levels of LDL, nicknamed “bad” cholesterol, increase the risk of atherosclerosis.

lumen: the inside diameter of a blood vessel or hollow organ.

occlusion: an obstruction or closure of a passageway or vessel.

stent: a tube-like device that is inserted into a vessel or passageway to keep it open.

transient ischemic attack (TIA): a “mini” stroke caused when blood flow to the brain is temporarily interrupted and then restored; causes no permanent brain damage.

updated > 4.2018
reviewed by > Andrew Ringer, MD, Mayfield Clinic

Hardening of the arteries Information | Mount Sinai

Arnett DK, Blumenthal RS, Albert MA, Buroker AB, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74(10):1376-1414.PMID: 30894319 pubmed.ncbi.nlm.nih.gov/30894319/.

Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 48.

James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. PMID: 24352797 pubmed.ncbi.nlm.nih.gov/24352797/.

Libby P. The vascular biology of atherosclerosis. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 44.

Marks AR. Cardiac and circulatory function. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 47.

US Preventive Services Task Force website. Final recommendation statement: statin use for the primary prevention of cardiovascular disease in adults: preventive medication. Updated November 13, 2016. Accessed January 28, 2020. www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/statin-use-in-adults-preventive-medication1.

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):2199-2269. PMID: 2914653 pubmed.ncbi.nlm.nih.gov/29146533/.

Last reviewed on: 1/27/2020

Reviewed by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Carotid Artery Disease – Conditions – For Patients – UR Neurosurgery

For more information, please visit our Cerebrovascular, Stroke and Endovascular Program site

What is carotid artery disease?

Carotid artery disease, also called carotid artery stenosis, occurs when the carotid arteries, the main blood vessels that carry oxygenated blood to the brain, become narrowed. The narrowing of the carotid arteries is most commonly related to atherosclerosis (a build-up of plaque, which is a deposit of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of an artery).

Atherosclerosis, or “hardening of the arteries,” is a vascular disease (disease of the arteries and veins). Carotid artery disease is similar to coronary artery disease, in which blockages occur in the arteries of the heart, and may cause a heart attack.

To better understand how carotid artery disease affects the brain, a basic review of the anatomy of the circulation system of the brain follows.

What are the carotid arteries?

The main supply of blood to the brain is carried by the carotid arteries. The carotid arteries branch off from the aorta (the largest artery in the body) a short distance from the heart, and extend upward through the neck carrying oxygen-rich blood to the brain.

There are four carotid arteries: the right and left internal carotid arteries and the right and left external carotid arteries. One pair (external and internal) is located on each side of the neck. Just as a pulse can be felt in the wrists, a pulse can also be felt on either side of the neck over the carotid arteries.

Why are the carotid arteries important?

Because the carotid arteries deliver blood to the brain, carotid artery disease can have serious implications by reducing the flow of oxygen  to the brain. The brain needs a constant supply of oxygen in order to function. Even a brief interruption in blood supply can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen. If the narrowing of the carotid arteries becomes severe enough to block blood flow, or a piece of atherosclerotic plaque breaks off and obstructs blood flow to the brain, a stroke may occur.

What causes carotid artery disease?

Atherosclerosis is the most common cause of carotid artery disease. It is unknown exactly how atherosclerosis begins or what causes it. Atherosclerosis is a slow, progressive, vascular disease that may start as early as childhood. However, the disease has the potential to progress rapidly. It is generally characterized by the accumulation of fatty deposits along the innermost layer of the arteries. If the disease process progresses, plaque formation may take place. Plaque is made up of deposits of smooth muscle cells, fatty substances, cholesterol, calcium, and cellular waste products. This thickening narrows the arteries and can decrease blood flow or completely block the flow of blood to the brain.

Risk factors associated with atherosclerosis include:

• older age
• male
• family history
• race or ethnicity
• genetic factors
• hyperlipidemia (elevated fats in the blood)
• hypertension (high blood pressure)
• smoking
• diabetes
• obesity
• diet high in saturated fat
• lack of exercise

A risk factor is anything that may increase a person’s chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases have different risk factors.

Although these risk factors increase a person’s risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. Knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

What are the symptoms of carotid artery disease?

Carotid artery disease may be asymptomatic (without symptoms) or symptomatic (with symptoms). Asymptomatic carotid disease is the presence of a significant amount of atherosclerotic build-up without obstructing enough blood flow to cause symptoms. However, a sufficiently tight stenosis will not always cause symptoms.

Symptomatic carotid artery disease may result in either a transient ischemic attack (TIA) and/or a stroke (brain attack).

A transient ischemic attack (TIA) is a sudden or a temporary loss of blood flow to an area of the brain, usually lasting a few minutes to one hour. Symptoms usually go away entirely within 24 hours, with complete recovery.

Symptoms of a TIA may include, but are not limited to, the following:

• sudden weakness or clumsiness of an arm and/or leg on one side of the body
• sudden paralysis (inability to move) of an arm and/or leg on one side of the body
• loss of coordination or movement
• confusion, dizziness, fainting, and/or headache
• numbness or loss of sensation (feeling) in the face
• numbness or loss of sensation in an arm and/or leg
• temporary loss of vision or blurred vision
• inability to speak clearly or slurred speech

TIA may be related to severe narrowing or blockage or from small pieces of an atherosclerotic plaque breaking off, traveling through the bloodstream, and lodging in small blood vessels in the brain. With TIA, there is rarely permanent brain damage.

Call for medical help immediately if you suspect a person is having a TIA, as it may be a warning sign that a stroke is about to occur. Not all strokes, however, are preceded by TIAs.

Stroke is another indicator of carotid artery disease.

The symptoms of a stroke are the same as for a TIA. A stroke is loss of blood flow (ischemia) to the brain that continues long enough to cause permanent brain damage. Brain cells begin to die after just a few minutes without oxygen. The area of dead cells in tissues is called an infarct.

The area of the brain that suffered the loss of blood flow will determine what the physical or mental disability may be. This may include impaired ability with movement, speech, thinking and memory, bowel and bladder function, eating, emotional control, and other vital body functions. Recovery from the specific ability affected depends on the size and location of the stroke. A stroke may result in problems such as weakness in an arm or leg or may cause paralysis, loss of speech, or even death.

The symptoms of carotid artery disease may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is carotid artery disease diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for carotid artery disease may include any, or a combination, of the following:

• auscultation (listening to) of carotid arteries – placement of a stethoscope over the carotid artery to listen for a particular sound called a bruit (pronounced brew-ee). A bruit is an abnormal sound that is produced by blood passing through a narrowed artery. A bruit is generally considered a sign of an atherosclerotic artery; however, an artery may be diseased without producing this sound.
• carotid artery duplex scan – a type of vascular ultrasound study performed to assess the blood flow of the carotid arteries. A carotid artery duplex scan is a noninvasive (the skin is not pierced) procedure. A transducer sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer (like a microphone) is placed on the carotid arteries at certain locations and angles, the ultrasonic sound waves move through the skin and other body tissues to the blood vessels, where the waves echo off of the blood cells. The transducer picks up the reflected waves and sends them to an amplifier, which makes the ultrasonic sound waves audible. Absence or faintness of these sounds may indicate an obstruction to the blood flow.
• magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• magnetic resonance angiography (MRA) – a noninvasive diagnostic procedure that uses a combination of magnetic resonance technology (MRI) and intravenous (IV) contrast dye to visualize blood vessels. Contrast dye causes blood vessels to appear opaque on the MRI image, allowing the physician to visualize the blood vessels being evaluated.
• computed tomography scan (Also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• angiography – an invasive procedure used to assess the degree of blockage or narrowing of the carotid arteries by taking x-ray images while a contrast dye in injected. The contrast dye helps to visualize the shape and flow of blood through the arteries as x-ray images are made.

Treatment for carotid artery disease:

Specific treatment for carotid artery disease will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your signs and symptoms
• your tolerance of specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Carotid artery disease (asymptomatic or symptomatic) in which the narrowing of the carotid artery is less than 50 percent is most often treated medically. Asymptomatic disease with less than 70 percent narrowing may also be treated medically, depending on the individual situation.

Medical treatment for carotid artery disease may include:

• modification of risk factors– risk factors that may be modified include smoking, elevated cholesterol levels, elevated blood glucose levels, lack of exercise, poor dietary habits, and elevated blood pressure.
• medications– medications that may be used to treat carotid artery disease include:
  • antiplatelet medications – medications used to decrease the ability of platelets in the blood to stick together and cause clots. Aspirin, clopidogrel (Plavix®), and dipyridamole (Persantine®) are examples of antiplatelet medications.
  • anticoagulants – also described as “blood thinners,” these medications work differently than antiplatelet medications to decrease the ability of the blood to clot. An example of an anticoagulant is warfarin (Coumadin®).
  • antihyperlipidemics – medications used to lower lipids (fats) in the blood, particularly cholesterol. Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor®), atorvastatin (Lipitor®), and pravastatin (Pravachol®), among others. Studies have shown that certain statins can decrease the thickness of the carotid artery wall and increase the size of the lumen (opening) of the artery.
  • antihypertensives – medications used to lower blood pressure. There are several different groups of medications which act in different ways to lower blood pressure.

In persons with narrowing of the carotid artery greater than 50 percent to 69 percent who do not have symptoms, a more aggressive treatment may be recommended (and if the narrowing increases, then surgery may be an option). However, if patients do have symptoms (that are directly referable to a carotid artery with >50% narrowing), early surgery is recommended, typically within 2 weeks of symptoms. Surgical treatment decreases the risk for stroke after symptoms such as TIA or minor stroke in patients with >50% narrowing of the carotid artery.

Surgical treatment of carotid artery disease includes:

• Carotid endarterectomy (CEA)– Carotid endarterectomy is a procedure used to remove plaque and clots from the carotid arteries, located in the neck. In appropriate patients, this can help prevent a stroke from occurring.
• Carotid artery angioplasty with stenting (CAS)– Carotid angioplasty with stenting is an option for patients who are high risk for carotid endarterectomy. This is a minimally invasive procedure in which a very small hollow tube, or catheter, is advanced from a blood vessel in the groin to the carotid arteries. Once the catheter is in place, a balloon may be inflated to open the artery and a stent is placed. A stent is a cylinder-like tube made of thin metal-mesh framework used to hold the artery open. Because there is a risk of stroke from bits of plaque breaking off during the procedure, an apparatus, called an embolic protection device, may be used. An embolic protection device is a filter (like a small basket) that is attached on a guidewire to catch any debris that may break off during the procedure.

View our medical encyclopedia for more information.

Carotid Artery Disease Risks, Signs, Diagnosis & Treatment

Risks of Carotid Artery Disease

• older age
• male
• family history
• race or ethnicity
• genetic factors
• hyperlipidemia (elevated fats in the blood)
• hypertension (high blood pressure)
• smoking
• diabetes
• obesity
• diet high in saturated fat
• lack of exercise

Risks of carotid artery disease

 include anything that may increase a person’s chance of developing a disease. It may be an activity, such as smoking, diet, family history or many other things. Different diseases have different risk factors.

Although these factors increase a person’s risk of carotid artery disease, they do not necessarily cause the disease. Some people with one or more risk factors never develop carotid artery disease, while others develop disease and have no known risk factors. Knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

Symptoms of Carotid Artery Disease

Carotid artery disease may be asymptomatic (without symptoms) or symptomatic (with symptoms). Asymptomatic carotid disease is the presence of a significant amount of atherosclerotic build-up without obstructing enough blood flow to cause symptoms.

Symptoms of carotid artery disease

(or symptomatic carotid artery disease) may result in either a transient ischemic attack (TIA) and/or a stroke (brain attack).

A transient ischemic attack (TIA) is a sudden or a temporary loss of blood flow to an area of the brain, usually lasting less than five minutes but not longer than 24 hours, with complete recovery. Symptoms of a TIA may include, but are not limited to, the following:

• sudden weakness or clumsiness of an arm and/or leg on one side of the body
• sudden paralysis (inability to move) of an arm and/or leg on one side of the body
• loss of coordination or movement
• confusion, dizziness, fainting and/or headache
• numbness or loss of sensation (feeling) in the face
• numbness or loss of sensation in an arm and/or leg
• temporary loss of vision or blurred vision
• inability to speak clearly or slurred speech

Diagnosis of Carotid Artery Disease

Your doctor will review your complete medical and family history and perform a physical examination to diagnose carotid artery disease. As part of the examination, the doctor will listen to your carotid arteries with a stethoscope for bruits, which are swooshing sounds that may indicate changes in your blood flow. They will determine whether you have any major risk factors for carotid artery disease. They will also evaluate any signs or symptoms of a mini-stroke or stroke. Your doctor may then order several tests to diagnose your condition and the severity of the condition. Those tests may include, carotid artery duplex scan, MRI, MRA, CT scan or angiography.

Carotid Artery

  Disease Treatment

Carotid artery disease treatment

may include modification of risk factors or medications. Surgical treatment of carotid artery disease includes a carotid endarterectomy or carotid artery angioplasty with stenting.

Specific carotid artery disease treatment will be determined by your physician based on:

• your age, overall health and medical history
• extent of the disease
• your signs and symptoms
• your tolerance of specific medications, procedures or therapies
• expectations for the course of the disease
• your opinion or preference

Causes of Carotid Artery Disease

As we age, cholesterol, calcium and fatty substances build up in our arteries, creating plaque deposits that narrow the arteries and increase our risk for cardiovascular disease, including both carotid artery disease and coronary artery (heart) disease. While coronary artery disease reduces blood flow to the heart and can cause a heart attack, carotid artery disease reduces blood flow in the neck arteries that supply blood to the brain, potentially causing a stroke.

While some of the risk factors for carotid artery disease are determined by heredity, the good news is that others can be managed through lifestyle changes. In conjunction with your care team, you can evaluate your risk factors and develop a plan for managing your health.

Risk Factors You Can Manage with Your Care Team

Talk with your physician about your risk factors for carotid artery disease and stroke. The following risk factors are all ones that can be managed through lifestyle changes and/or medication.

Smoking. Blood vessels are equipped with a smooth inner lining that can slow the process of atherosclerosis, or “hardening of the arteries.” Cigarette smoking contributes directly to carotid artery disease by damaging the smooth inner lining of arteries throughout the body. This damage diminishes the ability of the arteries to prevent blockages and contributes to the formation of plaque deposits on damaged areas of the arteries. Smoking also increases blood pressure and lowers levels of “good” cholesterol, thereby increasing other risk factors.

High blood pressure. A blood pressure over 140/90 is considered high blood pressure. If your blood pressure is unmanaged and above this mark, then you are at increased risk of having carotid arteries prone to damage and blockage from hardening of the arterial wall. High blood pressure places stress on the artery walls that can cause scarring, rupture and the formation of plaque deposits over time. Learn more about managing your blood pressure.

High “bad” cholesterol level. A high level of LDL cholesterol in the blood (sometimes referred to as “bad” cholesterol) leads directly to cholesterol deposits in the arteries. Exercise, medication and diet all can contribute to controlling cholesterol levels and reducing the risk of carotid artery disease.

Diabetes. Patients with diabetes are more likely to have high blood pressure as well as high cholesterol, both of which can cause atherosclerosis. Click here to learn more about diabetes and how it is linked with heart disease.

Obesity. Being overweight contributes to high blood pressure and diabetes, both of which increase the risk of carotid artery disease. Managing your weight may reduce multiple risk factors. Click here for ideas for managing weight through a healthy diet and exercise…

Physical inactivity. If you are diagnosed with carotid artery disease, your physician may prescribe exercise as part of your wellness plan. Exercise reduces the incidence of a number of other carotid artery disease risk factors, including diabetes, obesity, high blood pressure and high cholesterol. Click here for ideas for becoming more physically active.

Risk Factors You Can’t Control

Some risk factors for carotid artery disease and stroke are out of your control. If you are at greater risk based on the factors below, it is especially important to manage the risk factors you can control, such as high blood pressure or smoking.  

Age. Plaque build-up in the arteries is a natural part of the aging process, but also one that can be hastened by poor diet and other factors. The build-up of plaque in adults increases with age. Between the ages of 50 and 59, about 1 percent of adults have major plaque build-up in the carotid arteries. By the time they are 80–89 years old, 10 percent of adults have substantial plaque build-up. Men are at higher risk under the age of 75, while women face the greatest risk after age 75.

Heredity. A family history of atherosclerosis is a risk factor for carotid artery disease. If you have a family member with coronary artery disease, carotid artery disease, or peripheral artery disease, then you are at risk for these diseases as well.

Learn More

If you are concerned about carotid artery disease, you may wonder if you are at risk for stroke. The SecondsCount Stroke Risk Quiz can help you sort myth from fact when it comes to stroke risk.If you have already been diagnosed with carotid artery disease, learning more about stroke and its risk factors will help you understand the complete picture of why and how the disease process must be slowed. Your physician will discuss your treatment options with you.

If you are at risk for carotid artery disease, it is also important to know that you are at risk of coronary artery disease (heart attack), peripheral artery disease (leg and foot complications), and renal artery disease (kidney complications). The same disease process of plaque building up in arteries is behind all of these conditions.

Damage to the vessels of the neck

Damage to the vessels of the neck (pre-cerebral parts of the arteries of the brain).

Brachiocephalic arteries (BCA) are the main vessels of the body. BCA includes:

• brachiocephalic trunk,
• common carotid artery (divided into internal and external arteries)
• subclavian arteries,
• vertebral arteries.

The anatomy of the vertebral arteries is often individual.The internal carotid and vertebral arteries (they are also the precerebral parts of the cerebral arteries), after penetrating into the skull, form the circle of Willis. This anatomical formation is designed to ensure an even distribution of blood throughout all parts of the brain.

The problem is that the anatomy of the Wilisian circle is also variable, and in more than 20% of people in the European population, the circle is open. With this feature of anatomy, it is enough to stop blood circulation even in one of the arteries for the development of a stroke (death of brain tissue).

However, the overwhelming number of ischemic strokes of an embologic nature is . This means that the cause of the disease is the clogging of the arteries of the brain with material objects.

Embolism can be caused by blood clots from the cavities of the heart (with its pathology), but most often these are fragments of disintegrating atherosclerotic plaques from the carotid arteries and the zone of division of the common carotid artery into internal and external (bifurcation zone). It is the bifurcation zone that is a typical place for the onset and development of an atherosclerotic plaque.

Plaques, in turn, are divided into different types and are classified according to the degree of vasoconstriction. The most dangerous are embologenous plaques – that is, those that can collapse at any moment and all of their contents will instantly clog many arteries in the brain and cause a stroke.

The harbingers of stroke can be:

• headache;
• dizziness;
• numbness of half of the body;
• visual impairment;
• Difficulty formulating thoughts.
• violation of articulation
• disorders in fine functions of the hands (for example, when writing)
• Difficulty walking, etc.

Very often, a stroke occurs without any precursors. That is why ultrasound diagnostics of neck arteries (triplex, duplex scanning) is an absolutely necessary procedure for men and women after 40-50 years.

Angiosurgeons of the St. Petersburg Hospital of the Russian Academy of Sciences use various methods of treating atherosclerosis of the BCS, in the case of the carotid arteries, this is primarily carotid endarterectomy – a radical surgical treatment that allows you to remove a plaque and restore the integrity of the vessel wall.

The operation is carried out according to the technique providing the highest possible degree of protection of the brain and microsurgical restoration of the artery.

To date, carotid endarterectomy gives the most stable positive results at long-term follow-up periods – from 5 to 20 ~ 25 years. That is why in countries with developed medicine, carotid endarterectomy is the main method of treating this pathology.

For other affected areas in the St. Petersburg hospital of the Russian Academy of Sciences, artery transplants and shunting operations are performed.

You can get expert advice and learn more through the contact center 323 45 35

How to deal with atherosclerosis? – Rossiyskaya Gazeta

Acute heart failure, angina pectoris, cerebrovascular accidents, heart attacks, strokes do not spare neither the elderly nor the young today. We have such diagnoses in 58 percent of certificates stating death.

At risk – all

Among those in whose name such sad certificates are issued, every year there are more and more young people who did not manage to live up to thirty.The last diagnosis for them is often the first: after all, outwardly they seemed to be absolutely healthy people. The cause of death is a chronic “shortage” of oxygen to the tissues of the heart and brain. And at some unexpected moment – its complete cessation.

In the overwhelming majority of cases, oxygen “underfeeding” and the blockade is organized by atherosclerosis. The literal translation from Greek is “hardening of gruel”. Gruel – Cholesterol (protein-related fat). It consists of the nucleus of cholesterol plaques disfiguring blood vessels.Over time, the nucleus grows with the connective tissue of the vessel injured by the plaque. Various substances, such as calcium, are involved in the formation of plaques. Similar “stalactites” and “stalagmites” are found during the autopsy of men who died in the third decade, in women – in the fourth. But until about 70 years of age, men hold the lead in terms of the prevalence of plaques. “Atherosclerotic gender equality” is restored only after eighty – in men and women who died at this and later age, the quality and “dislocation” of these formations are approximately the same.But, even complicated ones, they do not always kill plaques: in many people of mature age, atherosclerosis is sluggish.

First symptoms – immediately after birth

More than half a century ago, American doctors were amazed at the results of one massive pathological and anatomical examination. The bodies of young soldiers killed in the war in North Korea were subjected to it. In more than half of twenty-year-old boys, the lumen of the arteries feeding the heart was found to be twice the norm due to atherosclerotic growths.But the soldiers during their lifetime were examined more than once, and they did not complain about their health.

Atherosclerosis is invisible for the time being: the symptoms of the diseases generated by it appear when the vessels are already closed by three quarters. The very first deposits of cholesterol appear when … a person also cannot really walk. The so-called fat spots, spots and stripes appear in the aortas of half of children under one year of age and in almost all (96 percent) between the ages of 4 and 16. However, by the time of puberty, all “hints of atherosclerosis” disappear.Almost. About a tenth of them remain in “combat readiness”.

There are rare lucky people who do not have cholesterol plaques and never have. There are also “unhappy” people, for example, the owners of the liver, “not able” to recognize and remove cholesterol from the body. As a result, the blood is “overpopulated” with cholesterol, and in this case there can be no question of any disappearance of fatty stripes and stains by the beginning of adulthood.

According to statistics, about one person in five hundred has an “inept” liver.A predisposition to atherosclerosis can also cause other metabolic disorders. Inherited or developed due to diseases, dietary habits of the way of life. That is why the Americans, who have realized the danger, conduct prevention of atherosclerosis even in children. After all, even a not too large cholesterol plaque under unfavorable circumstances (increased blood pressure, physical stress) can crack and burst. And since the plaque “bathes in blood”, a blood clot forms around it – a thrombus.Such a blood clot most often blocks the blood flow.

Atherosclerotic deposits can form in a wide variety of arteries. If the renal artery is damaged, for example, the kidneys become ill. With damage to the arteries of the legs, intermittent claudication develops. (In men, it is usually preceded by the development of impotence. However, this does not mean that every limping man is impotent.) Plaques, fraught with blood clots, form mainly in the vessels that feed the heart and brain: in the aorta, coronary and carotid arteries.Moreover, in certain areas – in the areas of branching and folds of blood vessels – places where the blood pushed out of the heart especially “indelicately” comes into contact with the intravascular lining (it is called the endothelium).

What delicacy, though? With each beat (that is, 60 – 70 times a minute), the heart “hurls” a third of a glass of blood into practically the same area of ​​the aorta. And under such pressure that portion by portion, this third of the glass comes into contact with the wall of the vessel at a speed of 25 meters per second.And so all my life …

Cholesterol, considered today the worst vascular destroyer, adheres only to damaged areas of the endothelium. And the more there are, the stronger the consequences. Indeed, in a healthy vessel, the endothelium can fight cholesterol, blood clots, and spasms. For example, if, having “tested” the composition of the blood, he “understands” that the vessels need to be dilated, he produces a vasodilator, and then there is no hypertension.

Healthy endothelium does not allow microorganisms to multiply in its tissues.And, by the way, there are a lot of them in cholesterol plaques. Mostly these are the causative agents of herpes and … colds. We are talking about one of the three known varieties of chlamydia – not the one that is sexually transmitted, but the one that enters the body when someone sneezes and coughs nearby. It causes acute respiratory infections and pneumonia. And today, research is underway to understand: does chlamydia enter ready-made cholesterol plaques or, on the contrary, takes an active part in their formation?

Helpers and accomplices

Diabetes, nervous, hormonal disorders, metabolic disorders, and diseases of the digestive system contribute to damage to the endothelium and the development of plaques.All this is a consequence of a violation of humoral regulation, that is, the coordination of processes occurring in the body through its liquid media (blood, lymph, tissue fluid). And the nervous system is in charge of all regulation. When its balance is disturbed, systems fail.

However, more often the balance is upset not so much because of life circumstances, but because of our reaction to them. The best neuro-hormonal background provides the type of human response that we call “benevolence”.It is benevolence and tranquility that give a chance for healing. After all, atherosclerotic plaques in the body not only form, but also disintegrate, “dissolve”, and the damaged endothelium is still restored. If you start to live so that the process of recovery is faster than the process of destruction, the disease can be controlled.

By the way

“French” paradox

The inhabitants of the Mediterranean countries are generally distinguished by good health.This is helped by the peculiarities of their cuisine – fresh fruits and vegetables, non-crushed cereals. But there is also something that does not fit into the concept of a healthy diet. For example, researchers have long tried to understand the “French” paradox. The bottom line is simple: French people consume as much, if not more, saturated fat than Americans, but the death rate from heart disease among men in France is less than 40 percent of the same rate for America. Why?

Most likely, the local dry red wine helps the French to protect themselves from heart ailments, which many of them drink one or two glasses a day.This is most likely a matter of the substance resveratrol, which is produced by red and black grapes during the ripening process to protect against fungus. This substance is essentially a natural pesticide. But as a result of animal studies conducted in Japan, it was found that resveratrol, in addition, helps to reduce the content of fat and cholesterol in the blood.

Citrus fruits also fight against fat and cholesterol, in particular the substance pectin, which is secreted from grapefruit. Pectin is a soluble fiber found only in citrus fruits themselves, but absent in juice.In an experiment conducted by researchers on animals that were fed a high-fat diet for a year, the number of plaques on the walls of blood vessels in patients with pectin and atherosclerosis was 62% less than in the control group.

Digit

1 percent of all deaths were attributed to cardiovascular disease in 1900. Since the mid-60s, atherosclerosis began to attack rapidly. Today, diseases of the heart and blood vessels are the cause of more than half of all deaths in the world.

practice

How to help yourself without medication

Several simple ways to prevent disease

How to deal with atherosclerosis? To remove excess fat and cholesterol from the body, there are special drugs. But, like any medicine, they have side effects.

Fortunately, atherosclerosis is very responsive to non-drug treatments and prophylaxis.Responsive to the point that even the World Health Organization recommends using them in the first place. Scientists claim that atherosclerosis is everyone’s disease, and cancer is by choice. That is, these diseases are based on the same disorders.

Calm, and only calm!

We have already said that benevolence, as a character trait, helps prevent illness. How do you feel about people and yourself? Here are some more tips.

1.In difficult life situations, try not to lose confidence. Remember that a depressed state of mind knocks all body systems out of rhythm.

2. See your doctor regularly to control your blood cholesterol levels.

3. Measure blood pressure often.

4. Move more. This helps to keep all the processes going on in the body in balance and fight excess weight.

5. Stop smoking. Nicotine destroys the endothelium.The amino acid taurine helps to neutralize the effect of nicotine at least partially – it is especially abundant in fatty fish. Enough 100 grams of such fish per day.

Don’t turn food into an enemy

To prevent atherosclerosis, you should limit the consumption of egg yolks, liver, kidneys, brains, lard, butter, sour cream and fatty meats.

The milk you consume should contain no more than 1 percent fat.

Cooking should only be done with vegetable oil (sunflower or olive).

From meat products, chicken and turkey without skin, young lamb, veal, lean beef are preferred.

We need to eat more fish. Fatty is especially good, but any boiled and stewed is useful – preferably not fried or salted.

Plant foods should be the basis of the diet: vegetables, peas, beans, lentils, cereals, fruits.

It is good to include the following gifts of nature in salads and teas:

90 150 beets, apples, garlic;

black currant, seaweed;

cabbage, onions, garlic, lingonberries, strawberries;

90 150 dandelion, clover, acacia flowers;

90 150 leaves of linden, raspberry, strawberry, black currant;

90 150 larch needles, hop cones;

tops of beets, carrots, radishes, radishes, celery, rhubarb, asparagus.

Dressing salads is better with sour milk, horseradish, applesauce.

Herbal Recipes

But to be treated with “herbs for atherosclerosis”, you need to know well all their properties, and all your diseases too. Take plantain, for example. It fights bacteria perfectly, but at the same time it can dramatically lower blood pressure. What if it is already low for you? And will plantain lower it when you drive or cross the road? That is why competent herbalists treat not one, but several (sometimes 10 – 15) herbs at once.The herbs cancel out possible unwanted effects. But remember: it is dangerous to make a collection for yourself using a book on your own. Herbs can do a lot, but only under the supervision of a competent specialist.

And one more thing: the manifestations of atherosclerosis are many-sided and, as already mentioned, are noticeable mainly already only in the serious stages of the disease. Therefore, it is even better to prevent atherosclerosis with regular medical examinations.

List of main conditions and diseases caused by atherosclerosis

Clinical manifestations of atherosclerosis

Symptoms of atherosclerosis of the vessels of the neck, head, coronary arteries

Symptoms and methods of treatment of cerebral atherosclerosis

Atherosclerosis is the deposition of cholesterol plaques on the inner surface of blood vessels, leading to their narrowing.The atherosclerotic process develops in the femoral, popliteal, tibial vessels (obliterating atherosclerosis of the vessels of the lower extremities), internal and external carotid arteries, cerebral vessels and coronary vessels. Complications of atherosclerosis account for 30-50% of deaths in persons aged 35-65 years.

Symptoms of atherosclerosis of the vessels of the neck

The first manifestations of the disease can occur at an early age. They are expressed in the appearance of lipid spots in the vessels, from which atherosclerotic plaques develop in the future.In the early stages of atherosclerosis, plaques do not interfere with blood flow and the disease does not manifest itself clinically. Over time, atherosclerotic plaques constrict the lumen of the vessels, which causes poor circulation. The onset of atherosclerotic stenosis leads to a stable deterioration in blood flow.

Symptoms of atherosclerosis depend on the localization of the process. Signs of atherosclerosis of the vessels of the head are transient ischemic attacks or stroke. With atherosclerotic narrowing of the coronary arteries, myocardial ischemia occurs, manifested by an attack of angina pectoris.Atherosclerosis of the coronary vessels of the heart in the elderly leads to myocardial infarction or sudden death. However, even complete occlusion (blockage) of an artery by plaque does not always result in a heart attack. Recurrent ischemia can contribute to the development of collateral circulation, which mitigates the effects of occlusion.

Atherosclerosis of the arteries of the lower extremities causes their ischemia and the development of intermittent claudication. The atherosclerotic process in the renal arteries leads to the development of persistent arterial hypertension.The defeat of the mesenteric arteries is manifested by symptoms of intestinal ischemia.

Symptoms of atherosclerosis of the vessels of the neck:

• headaches;
• memory impairment;
• periodic dizziness;
• emotional lability;
• visual impairment;
• speech problems.

In the later stages, small ruptures appear on the surface of the plaques, platelet adhesion is observed, blood clots form, which can completely block the lumen of the vessel, which leads to myocardial infarction or stroke.

How to treat cerebral atherosclerosis of blood vessels

Treatment of dyslipidemia begins with non-drug measures. Doctors recommend changing your lifestyle – quitting smoking, controlling weight, exercising, eating right (limiting foods high in cholesterol). The diet for atherosclerosis of the vessels of the legs includes the use of whole grains, a sufficient amount of vegetables, fruits, fish, seafood.

In the absence of the effect of non-drug measures, antihyperlipidemic agents are prescribed.The main drugs for the treatment of the disease “atherosclerosis” are statins. Their appointment significantly improves the prognosis of the life of patients with atherosclerosis. Studies have shown that drug therapy can lower low-density lipoprotein (LDL) cholesterol by 20% and total cholesterol by 26%. Mortality with regular use of statins is reduced by 22%.

Atherosclerosis is a systemic disease, it is treated, despite different pools, pathogenetically in the same way – Statins, GI sequestrants (if statins are ineffective or contraindicated).And also symptomatically, depending on the area of ​​the lesion and the severity of atherosclerotic stenosis of the atreria. For critical stenoses, surgical intervention is recommended, the type of which is determined by surgeons together with cardiologists

For more information on how to treat cerebral atherosclerosis of the vessels, see our website https://www.dobrobut.com.

Related services:
Cardiological Check-up
Diagnosis of cardiac arrhythmias by ECG monitoring

Atherosclerosis of the carotid arteries – Official website of the Federal State Budgetary Healthcare Institution KB No. 85 of the FMBA of Russia

Atherosclerosis is a lesion of the arteries accompanied by cholesterol deposits in the inner lining of blood vessels, narrowing of their lumen and malnutrition of the blood-supplied organ.Atherosclerosis of the vessels of the heart is manifested mainly by attacks of angina pectoris. Leads to the development of coronary heart disease (CHD), myocardial infarction, cardiosclerosis, vascular aneurysm. Atherosclerosis can lead to disability and premature death.

In atherosclerosis, arteries of medium and large caliber, elastic (large arteries, aorta) and muscular-elastic (mixed: carotid, cerebral and heart arteries) types are affected. Therefore, atherosclerosis is the most common cause of myocardial infarction, ischemic heart disease, cerebral stroke, circulatory disorders of the lower extremities, abdominal aorta, mesenteric and renal arteries.

In recent years, the incidence of atherosclerosis has reached alarming proportions, outstripping such causes as injuries, infectious and oncological diseases in terms of the risk of loss of working capacity, disability and mortality. With the greatest frequency, atherosclerosis affects men over 45-50 years of age (3-4 times more often than women), but it occurs in younger patients.

Atherosclerosis often affects the thoracic and abdominal aorta, coronary, mesenteric, renal vessels, as well as the arteries of the lower extremities and the brain.In the development of atherosclerosis, preclinical (asymptomatic) and clinical periods are distinguished. In the asymptomatic period, an increased content of β-lipoproteins or cholesterol is found in the blood in the absence of symptoms of the disease. Clinically, atherosclerosis begins to manifest itself when there is a narrowing of the arterial lumen by 50% or more. During the clinical period, three stages are distinguished: ischemic, thrombonecrotic and fibrous.

In the stage of ischemia, insufficient blood supply to an organ develops (for example, myocardial ischemia due to atherosclerosis of the coronary vessels is manifested by angina pectoris).In the thrombonecrotic stage, thrombosis of the altered arteries joins (for example, the course of atherosclerosis of the coronary vessels can be complicated by myocardial infarction). At the stage of fibrotic changes, connective tissue proliferates in poorly perfused organs (for example, atherosclerosis of the coronary arteries leads to the development of atherosclerotic cardiosclerosis).

The clinical symptoms of atherosclerosis depend on the type of arteries affected. The manifestation of atherosclerosis of the coronary vessels is angina pectoris, myocardial infarction and cardiosclerosis, consistently reflecting the stages of circulatory insufficiency of the heart.

The course of aortic atherosclerosis is long and asymptomatic for a long time, even in severe forms. Clinically, atherosclerosis of the thoracic aorta is manifested by aorthalgia – pressing or burning pains behind the sternum, radiating to the arms, back, neck, upper abdomen. Unlike pain in angina pectoris, aorthalgia can last for several hours and days, periodically weakening or worsening. A decrease in the elasticity of the aortic walls causes an increase in the work of the heart, leading to hypertrophy of the left ventricular myocardium.

Atherosclerotic lesion of the abdominal aorta is manifested by pain in the abdomen of various localization, flatulence, and constipation.With atherosclerosis of the bifurcation of the abdominal aorta, numbness and coldness of the legs, edema and hyperemia of the feet, necrosis and ulcers of the toes, intermittent claudication are observed.

The manifestations of atherosclerosis of the mesenteric arteries are attacks of “abdominal toad” and impaired digestive function due to insufficient blood supply to the intestines. In patients, the appearance of sharp pains a few hours after eating is noted. The pain is localized in the navel or upper abdomen. The duration of the painful attack is from several minutes to 1-3 hours, sometimes the pain syndrome is stopped by taking nitroglycerin.Bloating, belching, constipation, palpitations, and increased blood pressure appear. Later, fetid diarrhea with fragments of undigested food and undigested fat join.

Atherosclerosis of the renal arteries leads to the development of vasorenal symptomatic arterial hypertension. Erythrocytes, protein, casts are determined in urine. With unilateral atherosclerotic lesions of the arteries, there is a slow progression of hypertension, accompanied by persistent changes in urine and persistently high blood pressure.Bilateral damage to the renal arteries causes malignant arterial hypertension.

In atherosclerosis of the cerebral vessels, there is a decrease in memory, mental and physical performance, attention, intelligence, dizziness, and sleep disturbances. In cases of severe atherosclerosis of the cerebral vessels, the behavior and psyche of the patient changes. Atherosclerosis of the arteries of the brain can be complicated by acute disturbance of cerebral circulation, thrombosis, hemorrhage.

The manifestations of obliterating atherosclerosis of the arteries of the lower extremities are weakness and pain in the calf muscles of the lower leg, numbness and chilliness of the legs.The development of the syndrome of “intermittent claudication” is characteristic (pain in the calf muscles occurs when walking and subside at rest). Cold snap, pallor of the extremities, trophic disorders (peeling and dry skin, development of trophic ulcers and dry gangrene) are noted.

Diagnostics of atherosclerosis

Initial evidence for atherosclerosis is established by clarifying patient complaints and risk factors. Consultation with a cardiologist is recommended. During a general examination, signs of atherosclerotic lesions of the vessels of the internal organs are revealed: edema, trophic disorders, weight loss, multiple wen on the body, etc.Auscultation of the vessels of the heart and aorta reveals systolic murmurs. Atherosclerosis is evidenced by a change in arterial pulsation, an increase in blood pressure, etc.

Laboratory data indicate an increased level of blood cholesterol, low density lipoprotein, triglycerides. Radiographically, aortography reveals signs of aortic atherosclerosis: its lengthening, induration, calcification, expansion in the abdominal or thoracic regions, the presence of aneurysms. The condition of the coronary arteries is determined by coronary angiography.

Disturbances of blood flow in other arteries are determined by angiography – contrast radiography of the vessels. In atherosclerosis of the arteries of the lower extremities, according to angiography, their obliteration is recorded. With the help of ultrasound scan of the renal vessels, atherosclerosis of the renal arteries and the corresponding impairment of renal function are detected.

Methods of ultrasound diagnostics of the arteries of the heart, lower extremities, aorta, carotid arteries register a decrease in the main blood flow through them, the presence of atheromatous plaques and blood clots in the lumens of the vessels.Decreased blood flow can be diagnosed with rheovasography of the lower extremities.

Treatment of atherosclerosis

The following principles are adhered to in the treatment of atherosclerosis:

• limiting cholesterol entering the body and reducing its synthesis by tissue cells;
• increased excretion of cholesterol and its metabolites from the body;
• use of estrogen replacement therapy in postmenopausal women;
• impact on infectious agents.

Cholesterol intake from food is limited by the appointment of a diet that excludes cholesterol-containing foods.

The following groups of drugs are used for drug treatment of atherosclerosis:

• Nicotinic acid and its derivatives – effectively reduce the content of triglycerides and cholesterol in the blood, increase the content of high density lipoproteins with antiatherogenic properties. The prescription of nicotinic acid preparations is contraindicated in patients with liver disease.
• Fibrates (clofibrate) – reduce the synthesis of its own fats in the body. They can also cause abnormalities in the liver and the development of gallstone disease.
• Bile acid sequestrants (cholestyramine, colestipol) – bind and remove bile acids from the intestine, thereby lowering the amount of fat and cholesterol in cells. When using them, constipation and flatulence may occur.
• The drugs of the statin group (lovastatin, simvastatin, pravastatin) are the most effective for lowering cholesterol, i.e.to. reduce its production in the body itself. Statins are used at night, since cholesterol synthesis increases at night. Can lead to liver problems.

Surgical treatment for atherosclerosis is indicated in cases of high threat or development of arterial occlusion by plaque or thrombus. Both open operations (endarterectomy) and endovascular operations are performed on the arteries – with dilatation of the artery using balloon catheters and the installation of a stent at the site of narrowing of the artery, which prevents blockage of the vessel.

In case of severe atherosclerosis of the heart vessels, which threatens the development of myocardial infarction, coronary artery bypass grafting is performed.

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Single Line Text

Atherosclerosis of the aorta: diagnosis and treatment

Aortic atherosclerosis is a disease of the largest vessel in the human body, which is most often associated with disorders of fat metabolism.As a result of these violations, cholesterol plaques form on the inner membranes of the aorta and its main branches, the vessel walls lose elasticity over time, the lumen narrows, and the nutrition of the blood-supplied organs is disturbed.

Why is aortic atherosclerosis really dangerous?

The aorta is a vessel on which the blood supply and nutrition of almost all vital organs depend. From the thoracic region, where the aorta begins, departing from the heart, its branches go to the organs of the chest and the brain.From the abdominal section, where the aorta descends, branches branch off, feeding all the organs of the abdominal cavity, kidneys, small pelvis and lower limbs.
If the lumen of the aorta in the thoracic or abdominal region narrows or, worse, clogs up, a deficiency in blood supply develops in certain organs associated with the aorta, which can lead to life-threatening complications from all organs and systems.
Did you know that …

• Most often people over 60 suffer from atherosclerosis of the aorta and its branches, but it is possible to get sick even at a young age
• Sometimes the initial signs of aortic atherosclerosis are detected even in children 10-12 years old: this suggests that this disease can develop for decades without showing itself in any way
• The risk of developing atherosclerosis of the aorta is about twice as high if you are over 40, you smoke, drink alcohol, lead a sedentary lifestyle and abuse unhealthy food, such as fast food
• No one is immune from atherosclerosis: even if you watch your health from childhood and feel great, it is not a fact that you do not have this disease

Remember: to find out for sure how healthy your blood vessels are, contact our specialists who will carry out an accurate diagnosis and assess your risks.
Sign up now.

Stages of development of aortic atherosclerosis

• Ischemic – manifested by attacks of angina pectoris, lameness, abdominal pain, increased blood pressure
• Trombonecrotic – stage of life-threatening complications, including myocardial infarction, stroke, gangrene, renal failure and others
• Fibrous – when the disease develops for a long time, fibrous tissue replaces other types of tissue and disrupts the normal functioning of the corresponding organs

Please note: symptoms of aortic atherosclerosis begin to appear when the disease progresses and ischemia (lack of blood supply) develops in one of the areas of the blood-supplied organ.

Signs of aortic atherosclerosis

Symptoms of aortic atherosclerosis are different – it all depends on which area is affected and how advanced the disease is.

Signs of aortic atherosclerosis: thoracic

Abdominal aortic atherosclerosis: symptoms

Atherosclerosis of the abdominal aorta disrupts the blood supply to the internal organs and lower extremities, which is why the symptoms can be very varied:

• Pain in the navel – inconsistent “wandering” character, accompanied by bloating and constipation
• Increased blood pressure as a result of renal ischemia
• Weight loss – occurs due to disturbances in the digestive system
• No pulsation in the navel, under the knees and on the back of the feet
• Problems with sexual activity in men, infertility
• Calf pain when walking, which goes away when you stop
• Intermittent lameness
• Numbness of feet
• Cold feet
• Swelling and redness of the legs and feet
• Necrotic ulcers on the skin of the legs – occur in the last stages of the disease

Remember: aortic atherosclerosis is a dangerous disease that can develop for years without symptoms.If symptoms appear, then the disease is progressing and can at any time lead to complications that could cost you your life.

Therefore, do not delay the visit to the doctor. Make an appointment now.

Aortic atherosclerosis: complications

As a rule, complications of aortic atherosclerosis develop if the disease is not treated for years or treated incorrectly.

And a number of other life-threatening complications that can lead to death.

Aortic atherosclerosis: risk factors

There are many factors influencing the development of atherosclerosis. Let’s talk about the main ones.

Factors that cannot be eliminated:

• Age. The older you get, the higher your risk of developing aortic atherosclerosis. If you are over 50 years old, diagnosis is vital – even if there are no symptoms
• Pol. Men suffer from atherosclerosis in general and aortic atherosclerosis 4 times more often than women. After 55 years, the risk of the disease in both sexes is equalized, since the level of sex hormones – estrogens in women decreases, which, according to scientists, have a beneficial effect on the state and work of blood vessels
• Heredity.If one of your close relatives is sick or is sick with atherosclerosis of the aorta, your risk of developing this disease is much higher

Eliminating Factors:

• Smoking and alcohol. Nicotine and other harmful substances contained in tobacco smoke, as well as alcohol, provoke vasospasm, which increases the risk of narrowing the lumen significantly.
• Incorrect power supply. If you have too much animal fat in your diet, you have a higher risk of developing atherosclerosis, as they accelerate atherosclerotic changes in blood vessels
• Sedentary lifestyle.It provokes a fatty imbalance, which is one of the main causes of cholesterol deposits on the walls of blood vessels

Partially eliminable factors:

• Arterial hypertension. High pressure increases damage to the vascular wall, followed by the deposition of cholesterol in it and the formation of atherosclerotic plaques
• Dyslipidemia. Impaired fat metabolism is accompanied by an increase in the level of low and very low density lipoproteins (“bad cholesterol”), which accelerates the development of atherosclerosis
• Diabetes mellitus and obesity.If you are obese or diabetic, or worse, both, your risk of developing arteriosclerosis is 5-7 times higher
• Intoxication, infection. Toxic substances and infections damage the walls of blood vessels, which accelerates the development of atherosclerotic changes

Aortic atherosclerosis: diagnosis

Diagnostics begins with a consultation. Our specialist will devote as much time to you as it takes to collect all the necessary information: what exactly are you complaining about, whether you have any concomitant diseases, have any of your close relatives been sick or sick with atherosclerosis or other diseases of the cardiovascular system.
A general examination, which the doctor will conduct at the appointment, will help to identify or exclude various signs of atherosclerotic vascular lesions, for example, edema, trophic ulcers, weight loss or increase, and a number of other signs.
Auscultation (listening) of the vessels of the heart and aorta will help to identify or exclude murmurs, arterial pulsation disorders and other indicators.
A blood test will help to clarify the level of cholesterol, low density lipoproteins, triglycerides.
USDG will reveal signs of aortic atherosclerosis: its induration, expansion in the abdominal or thoracic regions, aneurysms, calcification.
Doppler ultrasound of the renal vessels will identify or exclude the presence of plaques in the renal arteries.
USDG of the vessels of the lower extremities, aorta, carotid arteries will help to determine how much the main blood flow in them is reduced, and also to reveal atheromatous plaques and blood clots in the lumens of the vessels.
If necessary, your doctor will refer you for coronary angiography to help you accurately assess the condition of your coronary arteries.
Please note: only such a comprehensive diagnosis will help you to make an accurate diagnosis, assess the degree of vascular lesions and choose the optimal treatment that will really help you.
Make an appointment now.

Aortic atherosclerosis: treatment

Correct treatment of aortic atherosclerosis is the only condition for successful recovery. To achieve this, we approach the drug therapy of aortic atherosclerosis in a comprehensive manner – as this disease requires:

• Reducing the level of cholesterol entering the body with food
• We remove existing cholesterol and its metabolites from the body
• We block the formation of “bad” cholesterol in the liver

Drug treatment

Drug treatment of aortic atherosclerosis includes several groups of drugs.Let’s discuss the main ones.

• Nicotinic acid and its derivatives
  Reduces the level of triglycerides and cholesterol in the blood. Increases the level of high density lipoproteins, which have antiatherogenic properties. Contraindicated in liver disease: if you have any, the doctor will select another medicine.
• Fibrates (miscleron, gevilan, atromide)
  Reduce the synthesis of their own fats, but can adversely affect the liver and provoke cholelithiasis. Statins (Zocor, Mevacor, Liprimar)
  Reduce the amount of “bad” cholesterol produced by the liver, and, as a result, lower its level in the blood. Statins are taken at night because cholesterol is synthesized, usually at night.
• Bile acid sequestrants (cholestide, cholestyramine)
  Bind and remove bile acids, reduce cholesterol and fat levels in the body. May cause constipation and flatulence.

Surgical treatment

Operations are prescribed when drug therapy does not help.How much surgery is necessary for you, and which method of surgical intervention will be effective in your case, will be determined by our specialists. Possible methods include:

Aortic atherosclerosis: prevention

Correct prevention is one of the key conditions for successful recovery, which cannot be neglected:

• Stop smoking and drinking alcohol
• Avoid foods and meals containing animal fats
• Treat concomitant diseases in time, if you have them: diabetes mellitus, arterial hypertension, obesity
• Lead an active lifestyle, move more, exercise, but do not overwork your body
• Don’t be nervous about trifles
• Treat infectious diseases in time
• Get check-ups and examinations annually, especially if you are over 40 years old

Diet for atherosclerosis of the aorta

Despite the fact that the proportion of cholesterol that we get from food is not very high (up to 25%), proper nutrition, combined with proper treatment and a healthy lifestyle, will significantly increase the effectiveness of treatment.

Products we recommend excluding:

• Sour cream
• Mayonnaise
• Sauces
• Chips
• Salted nuts
• Cocoa and chocolate
• White butter bread
• Pastries, biscuits, cakes, pastries
• Butter and sour cream
• Puddings and Ice Cream
• Cheese, margarine, fermented milk products
• Whole milk
• Coconut and palm oil
• Interior fat
• Butter, animal fats
• Pastes, hams, smoked sausages
• Fat duck or goose
• Offal (brain, kidney, liver)
• Fatty meat (pork, lamb, beef)

Foods to help lower cholesterol:

• Green salads
• Garlic
• Bow
• Dill
• Parsley
• Legumes
• Fruit
• Lean meat
• Molluscs
• Coarse flour
• Oat groats
• Bran
• Fatty sea fish (herring, mackerel, sardines, salmon, tuna)
• Vegetable oils

Remember: the sooner aortic atherosclerosis is detected, the higher the chance to stop the progression of this disease and prevent life-threatening complications.
Therefore, do not delay your visit to the doctor. Make an appointment now.

Chronic pancreatitis / Diseases / Clinic EXPERT

Chronic pancreatitis (CP) is a long-term inflammatory disease of the pancreas, with manifestations in the form of irreversible changes in the structure of the organ that cause pain and / or a persistent decrease in its function.

The pancreas performs important functions:

• the secretion of most digestive enzymes
• the production of insulin (a hormone with a deficiency of which diabetes mellitus develops)

There is a tendency towards an increase in the incidence of acute and chronic pancreatitis in the world, over the past 30 years – more than 2 times.

Reasons for the development of pancreatitis

The most common reason for the development of chronic pancreatitis is alcohol consumption, and the quality and raw materials from which the drink is made do not matter.

Other causes

1. Toxins and metabolic factors:
   • alcohol abuse
   • smoking
   • high blood calcium (develops in patients with a tumor of the parathyroid glands)
   • overnutrition and consumption of fatty foods
   • protein deficiency in food
   • the effect of drugs and toxins
   • chronic renal failure
2. Blockage of the pancreatic duct:
   • by stones in this duct
   • due to a malfunction of the sphincter of Oddi
   • closure of the duct by a tumor, cysts
   • posttraumatic endocrine scars procedures: papillosphincterotomy, stone removal, etc.
3. Pathology of the gallbladder and biliary tract.
4. Duodenal pathology.
5. Consequences of acute pancreatitis.
6. Autoimmune mechanisms.
7. Heredity (gene mutations, 1-antitrypsin deficiency, etc.).
8. Helminths.
9. Insufficient supply of oxygen to the pancreas due to atherosclerosis of the vessels supplying this organ with blood.
10. Congenital malformations of the pancreas.
11. Idiopathic chronic pancreatitis (cause cannot be established).

Symptoms of pancreatitis

• pain in the abdomen: usually the pain is localized in the epigastrium and radiates to the back, intensifying after eating and decreasing when sitting or leaning forward
• nausea, vomiting
• diarrhea (fatty feces), an increase in the volume of feces
• bloating, rumbling in the abdomen
• weight loss
• weakness, irritability, especially “on an empty stomach”, sleep disturbance, decreased performance
• symptom of “red droplets” – the appearance of bright red spots on the skin of the chest, back and abdomen.

If such symptoms appear, it is recommended to undergo an examination to exclude chronic pancreatitis.

Complications of chronic pancreatitis

In the absence of treatment, possible complications of chronic pancreatitis include:

• diabetes mellitus
• vitamin deficiency (mainly A, E, D)
• increased bone fragility
• cholestasis and without jaundice)
• inflammatory complications (inflammation of the bile ducts, abscess, cyst, etc.)
• subhepatic portal hypertension (accumulation of fluid in the abdominal cavity, enlargement of the spleen, dilated veins of the anterior abdominal wall, esophagus, liver dysfunction)
• effusion pleurisy (accumulation of fluid in the membranes of the lungs)
• compression of the duodenum with the development of intestinal obstruction
• Pancreatic cancer.

Severity of chronic pancreatitis

There are three degrees of severity of chronic pancreatitis:

Mild

• exacerbations rare (1-2 times a year), short-term
• moderate pain
• weight loss no
• no diarrhea fatty stools
• scatological studies of feces are normal (no neutral fat, fatty acids, soaps)

relapses.

Average degree

• exacerbations 3-4 times a year, occur with prolonged pain syndrome
• may appear an increase in amylase, lipase in the blood
• periodic loosening of stool, fatty feces
• there are changes in the coprogram

With an average degree the severity of chronic pancreatitis, a strict diet is required, longer courses of therapy, constant supervision of the attending physician.

Severe condition

• frequent and prolonged exacerbations with severe, prolonged pain syndrome
• frequent loose stools, fatty feces
• weight loss, up to depletion
• complications (diabetes mellitus, pseudocysts, etc.)

In severe chronic pancreatitis, constant supportive therapy, stronger medications and a strict diet are required. Often, patients need close supervision not only by a gastroenterologist, but also by doctors of other specialties (endocrinologist, surgeon, nutritionist). The resulting exacerbations, as well as complications of the disease, threaten the patient’s life and, as a rule, are an indication for hospitalization.

The presence of chronic pancreatitis, regardless of the severity, requires immediate medical attention, since without treatment and lifestyle changes,
the process will progress steadily.

Diagnostics of pancreatitis

The EXPERT Clinic has an algorithm for the diagnosis of chronic pancreatitis, which includes:

Laboratory methods:

• clinical, biochemical blood tests are performed (of particular importance is the level of pancreatic enzymes in the blood) – amylase
• , lipase coprogram – the presence of certain substances in the feces (fats, soaps, fatty acids, etc.) is assessed. Normally, they should be absent, and in chronic pancreatitis, due to insufficient production of enzymes by the gland for the breakdown of these substances, they remain undigested and are determined in feces
• fecal elastase – an enzyme of the pancreas, the level of which, with insufficient work, decreases
• in certain In cases it is important to determine cancer markers
• If a hereditary genesis of the disease is suspected, a genetic examination of the patient is carried out.

Instrumental examinations

• Ultrasound of the abdominal cavity. Signs of inflammation of the pancreatic tissue, the presence of stones in the ducts, calcifications, cysts, and tumors of the gland are evaluated. Additionally, changes from other organs of the gastrointestinal tract are determined to exclude complications of the disease, as well as concomitant pathology.

• Additionally, CT and MRI of the abdominal cavity with cholangiography, RHGP can be prescribed. They are necessary to confirm the diagnosis, and are also prescribed if there is a suspicion of the presence of pathological formations in the pancreas, blockage of the ducts of the gland with a stone, tumor or cyst.

Treatment of pancreatitis

The main treatment for chronic pancreatitis is diet and rejection of bad habits, lifestyle changes, as well as drugs:

• drugs that reduce the production of hydrochloric acid in the stomach (proton pump inhibitors)
• enzyme preparations
• antispasmodics
• in the presence of pain – analgesics, NSAIDs; if the pain is extremely severe and is not relieved by these drugs, narcotic analgesics are prescribed.

It is necessary to identify during the initial examination of the pathology of other organs of the gastrointestinal tract (gallstone disease, chronic cholecystitis, gastritis, duodenitis, peptic ulcer, hepatitis, bacterial overgrowth syndrome, intestinal dysbiosis, kidney disease, etc.), since these diseases can cause and / or aggravate chronic inflammation of the pancreas. In this case, treatment of other diseases of the gastrointestinal tract is necessary. The decision on the urgency and procedure for the treatment of a particular concomitant disease is made by the attending physician.

If medications taken by patients for other diseases can contribute to the development of the disease, the question of replacing drugs is decided.

All types of drug therapy should be prescribed and monitored by a gastroenterologist.

If any mechanical obstruction to the outflow of bile is detected, the patient is shown surgical treatment.

Prognosis

Chronic pancreatitis is a serious illness. However, when following the recommendations of the curator for the prevention of exacerbations (adherence to dietary recommendations, preventive treatment, etc.)) Chronic pancreatitis proceeds “calmly”, without frequent exacerbations and has a favorable prognosis for survival.

In case of violation of the diet, alcohol intake, smoking and inadequate treatment, degenerative processes in the tissue of the gland progress and severe complications develop, many of which require surgical intervention and can be fatal.

Prevention and recommendations

Prevention is based on the elimination of risk factors that provoke the disease:

• timely treatment of diseases that provoke the onset of pancreatitis
• elimination of the possibility of chronic intoxications that contribute to the development of this disease (industrial and also rational alcoholism)
• nutrition and daily regimen.

Nutrition for chronic pancreatitis

With pancreatitis, all dishes are made from lean meat and fish – and then only in a boiled version. Fried foods are prohibited. You can eat dairy products with a minimum percentage of fat. It is advisable to drink only natural juices and compotes and tea from liquid.

The following should be completely excluded:

• all types of alcohol, sweet (grape juice) and carbonated drinks, cocoa, coffee
• fried dishes
• meat, fish, mushroom broths
• pork, lamb, goose, duck
• smoked meats, canned food, sausages
• pickles, marinades, spices, mushrooms
• white cabbage, sorrel, spinach, lettuce, radishes, turnips, onions, rutabagas, legumes, raw non-grated vegetables and fruits, cranberries
• butter flour, black bread
• confectionery, chocolate, ice cream, jams, creams
• bacon, cooking fats
• cold food and drinks

A qualified nutritionist will help you think over the nutritional basics for chronic pancreatitis, make a diet and take into account the wishes and habits of the patient.

Frequently Asked Questions

Does the pancreas die off in chronic pancreatitis?

Chronic pancreatitis is a disease characterized by inflammation and degeneration, followed by the development of connective tissue in the organ and impaired digestive and endocrine function. “Dying off” of the gland is called pancreatic necrosis and occurs in acute pancreatitis, being a deadly condition

Why does pancreatitis develop if I don’t drink?

Indeed, in most cases, the development of pancreatitis is due to the action of alcohol, but there are other factors: gallstone disease, liver diseases characterized by impaired formation and outflow of bile, diseases of the stomach and duodenum, heredity, failure in the immune system, impaired blood supply to the organ , background diseases: viral hepatitis, hemochromatosis, cystic fibrosis, etc.

Can pancreatitis be cured?

Chronic pancreatitis is therefore called chronic because it cannot be completely cured, but the correct medical tactics allows you to achieve long-term remission.

Can pancreatitis lead to the development of diabetes mellitus?

Yes, a prolonged course of pancreatitis can lead to the development of not only a violation of the digestive function of the pancreas, but also a change in the endocrine function with the development of diabetes mellitus, especially in the presence of a hereditary predisposition to diabetes mellitus.

Is it important to follow a diet for pancreatitis?

Diet is fundamental to achieving remission.

Treatment stories

Story # 1

Patient H., 52 years old, came to the EXPERT Clinic with complaints of girdle pain after eating fatty foods and a little alcohol, nausea, loose stools.

From the anamnesis it is known that discomfort in the area above the navel with loosening of the stool was observed for several years with food inaccuracies, but after adhering to a strict diet, it disappeared without a trace.On this occasion, the woman was not examined. This is the first time that these complaints have arisen. In addition, 20 years ago during pregnancy, the patient was told about the presence of thick bile on ultrasound. In the future, the patient was not examined, since nothing bothered her.

During the laboratory and instrumental examination, changes in blood tests were revealed: increased ESR, pancreatic amylase activity, and with ultrasound, multiple stones in the gallbladder.

After relief of the pain syndrome, the patient was referred for planned surgical treatment – removal of the gallbladder.After a successful operation, the patient continues to be monitored by a gastroenterologist, follows dietary recommendations, has no complaints, the indicators have returned to normal.

History No. 2

Patient B., 56 years old, turned to the EXPERT Clinic with complaints of periodic intense pain syndrome of a shingles nature for no apparent reason, accompanied by nausea and diarrhea. At the previous stage of the examination, diffuse changes in the structure of the pancreas were revealed, which was regarded as chronic pancreatitis.At the same time, the patient led a healthy lifestyle, did not consume alcohol and fatty foods. The prescribed treatment with enzyme preparations had no significant effect.

While trying to find out the reason for the development of pancreatitis, the gastroenterologist of the EXPERT Clinic ruled out a number of diseases that could lead to the development of chronic pancreatitis (gallstone disease, peptic ulcer disease, iron metabolism disorders, etc.) and drew attention to the immunological shift in laboratory tests. This served as the basis for an in-depth immunological examination, which made it possible to establish that the cause of the defeat of the pancreas was a malfunction of the immune system – autoimmune pancreatitis.

A pathogenetic treatment was prescribed that influenced the mechanism of the disease development – glucocorticosteroids according to the scheme, against which the signs of immune inflammation were eliminated during the control examination. Currently, the patient is receiving long-term supportive therapy under the supervision of a curator, and has no complaints.