Article by vascular surgeon Nektarios Galanis in
Go! magazine
Carotid artery disease is the stroke "time bomb"
The carotid arteries are the main arteries that supply blood to the brain. The common carotid arteries pass through the neck and in the middle of it, approximately or just before the lower jaw, they divide into the external and internal carotid arteries . Stenosis of the internal and common carotid arteries is what plays the most important role in the blood supply to the brain .
As in the rest of the arteries of the body, under the influence of risk factors , such as smoking , diabetes , hyperlipidemia and hypertension , atherosclerotic plaques can form inside them, which cause narrowing of the lumen and disrupt blood flow to the brain. As this plaque grows, the likelihood of a clot forming on it or a piece of it breaking off increases, which, carried by the blood flow, can become “wedged” in a cerebral artery and cause the so-called ischemic stroke . By the term “carotid disease”, therefore, we refer to the narrowing or blockage of the common or internal carotid arteries.
Atherosclerosis is the main condition that causes narrowing and blockage of the arteries. Therefore, it is important to note that patients with carotid stenosis are at increased risk of suffering a myocardial infarction or developing peripheral occlusive arterial disease, and vice versa.
Symptoms
Carotid artery disease usually does not cause symptoms for a long time and, unfortunately, the first manifestation is often 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 , which can last from a few minutes to a few hours and are characterized as a transient ischemic attack . In any case, it is of utmost importance to recognize these warning signs and investigate them promptly.
Diagnosis
The diagnosis is based on ultrasound (color ultrasound angiography or triplex) digital, magnetic or CT angiography is required .
Treatment methods
Treatment depends on the degree of stenosis of the internal or common carotid artery and whether symptoms have preceded it. However, regardless of the treatment of the stenosis, prophylactic medication against arteriosclerosis also plays a very important role. The main pillars of this are the intake of an antiplatelet agent , as well as an antihyperlipidemic drug against cholesterol. Also important is the control of risk factors, such as quitting smoking, treating hypertension and controlling diabetes.
In general, surgical treatment is recommended in asymptomatic patients when the stenosis is >70%, while in symptomatic patients , when the stenosis is >50%. The above limits are not absolute, but other factors, such as age, and any coexisting diseases, such as coronary artery disease, are also taken into account.
Surgical treatment
There are two surgical treatment options, the classic "open" endarterectomy and the endovascular approach with stent placement.
In the classic method , which is still the "golden rule" of surgical treatment, the vessel is opened lengthwise from the common carotid artery to the internal carotid artery, the plaque is removed, and the incision is closed.
Endovascular treatment consists of opening the narrowed portion of the carotid artery by placing a stent , which is advanced through the femoral artery without surgical incisions.
Although the endovascular method is clearly less invasive, it carries greater risks of complications, mainly stroke during the procedure, so it is applied in special cases.
Both of these procedures are performed by my team under local anesthesia , which allows us to monitor brain function throughout the surgery and safely intervene if necessary. The hospital stay ranges from 1 to 2 days.