Article by Vascular Surgeon Nektarios Galani in
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Carotid disease is the "time bomb" of stroke
Carotids are the basic arteries that bloom the brain. The common carotids penetrate the throat and in its middle, or just before the lower jaw, are divided into the outside and inner carotid . The narrowing of the inner and the common carotid are the ones that play the key role in brain hemorrhage .
As with the other arteries of the body under the influence of risk factors , such as smoking , diabetes , hyperlipidemia and hypertension , atherosclerotic plaques can be created within them, which cause the lumen stenosis and disturb the blood flow to the brain. which can be "fed" in a brain artery and caused by the so -called ischemic stroke . By the term "carotid disease", we are referring to stenosis or obstruction of common or inner carotid arteries.
Arteriosclerosis is the basic condition that causes arteries stenosis and obstruction . Consequently, it is important to point out that patients with carotid stenosis have an increased risk of having myocardial infarction or disease from peripheral obstructive arterial disease and vice versa.
Symptoms
Carotid disease usually does not give symptoms for a long time and, unfortunately, often the first manifestation is a stroke . In some cases, however, it manifests with symptoms, such as sudden decrease or loss of vision, numbness or weakness on one side of the body, difficulty speaking or fainting episode , which may take a few minutes to a few hours and are characterized as transient ischemic . In any case, the recognition of these warning signs and their timely investigation is of the utmost importance.
Diagnosis
The diagnosis is based on the ultrasound (colored ultrasonic arteriography or triplex) of the cervical vessels. This test allows the vessel stenosis to be highly determined. In the case of diagnostic doubts, further control is required with digital, magnetic or axial angiography .
Treatment methods
The treatment depends on the degree of stenosis of the inner or common carotid and whether there have been symptoms. However, regardless of the treatment of stenosis, prophylactic medication against atherosclerosis also plays a very important role. The main pillars of this are the taking of an antiplatelet agent , as well as an anti -comparial drug against cholesterol. Also important is the control of risk factors, such as smoking cutting, treatment of hypertension and diabetes control.
In general, surgical treatment is recommended in asymptomatic patients when stenosis is> 7th%, while in symptomatic , when the stenosis is> 5%. The above limits are not entirely, but other factors are taken into account, such as age, and any coexisting diseases, such as coronary heart disease.
Surgery
There are two options for surgical treatment, classic "open" endartectomy and intravascular approach with stent.
In the classic method , which is still the "golden rule" of surgical treatment, the vessel is opened along the common carotid to the inner carotid, the removal of the plaque and the closure of the incision.
The intravascular treatment consists in opening the narrowed portion of the carotid by the placement of an intrastal , which is promoted through the femoral artery without surgical incisions.
Although the intravascular method is clearly less invasive, it has greater risks of complications, mainly stroke during procedure, so it is applied in special cases.
Both of these procedures are performed by my team with local anesthesia , which allows us to monitor the functioning of the brain at all phases of the operating room and to intervene safely if needed. The hospital stay ranges from 1 to 2 days.