What is Carotid Disease?
The common carotid arteries pass through the neck and approximately in the middle of it or just before the lower jaw they divide into the external and internal carotid arteries. Pathologies of the external carotid arteries do not require treatment because they do not actively participate in the blood supply to the brain. However, stenosis of the internal and common carotid arteries are the ones that focus our attention as they play the most important role in the blood supply to the brain.
As in the rest of the body's arteries, 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. The most dangerous thing, however, is that as this plaque grows, the likelihood of a clot forming on it or a piece of it breaking off increases, which, carried away by the blood flow, can become "wedged" in a cerebral artery and cause the so-called ischemic stroke.
By the term "carotid disease" , we refer to the narrowing or blockage of the common or internal carotid arteries.
As we will often see on the pages of this website, atherosclerosis is the main condition that causes narrowing and blockage of the arteries. Therefore, it is important to constantly point out that patients with carotid stenosis are at increased risk of suffering a myocardial infarction or developing peripheral occlusive arterial disease, and vice versa.
What are the symptoms of Carotid Disease?
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 itself 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, a stroke that the body managed to overcome either because the clot dissolved in time or because the piece of plaque that was detached was relatively small and did not block a large area of the brain. In any case, it is of utmost importance to recognize these warning signs and investigate them further in a timely manner in order to prevent greater and permanent damage, since patients with carotid stenosis and transient ischemic attacks have a stroke incidence of 35% in the first 5 years.
How is Carotid Disease diagnosed?
The diagnosis is based on ultrasound (color ultrasound angiography or triplex) of the vessels of the neck. This examination allows, through a morphological study of the atherosclerotic plaque (hard, soft, unstable), but also through dynamic measurements of the flow velocity in the points where the arteriosclerotic lesions are most intense, to determine with great precision the degree of stenosis of the vessel. In case of diagnostic doubts or suspicion of extension of the lesions to the parts of the vessels that run through the chest or the interior of the brain, further examination with digital, magnetic or CT angiography is required.
As part of a preoperative check-up, imaging of the brain via CT or MRI, as well as a special neurological examination.
What are the treatment methods for Carotid Disease?
The approach to the treatment of carotid artery disease depends on the degree of stenosis of the internal or common carotid artery and whether or not symptoms have preceded it. However, regardless of the recommended treatment of stenosis, prophylactic medication against arteriosclerosis also plays a very important role. The main pillars of this are the intake of an antiplatelet agent (aspirin/Salospir or clopidogrel/Plavix) as well as an antihyperlipidemic drug against cholesterol. Also important is the control of risk factors such as smoking cessation, treatment of hypertension and control of diabetes.
In general, surgical treatment is recommended in asymptomatic patients when the stenosis is >70% while in symptomatic patients, i.e. patients who have already had a stroke, when the stenosis is >50%. In symptomatic carotid stenosis >50% there is an indication for surgical treatment within 14 days from the onset of symptoms. In recurrent stroke symptoms or in complete thrombotic occlusion there is an indication for urgent surgical treatment.
The above limits are not absolute but other factors are taken into account such as age, any coexisting conditions that may increase the risk of surgery, such as coronary artery disease, as well as the quality of the atherosclerotic plaque since a soft and irregular plaque crumbles much more easily than a hard and smooth one.
Regarding surgical treatment, there are two options available, the classic endarterectomy and the endovascular approach with stent placement. In the classic, open surgical treatment, the part of the carotid artery that has the stenosis is opened, cleaned (endarterectomy) and closed, restoring blood flow to the brain through its natural path. My team has extensive experience in performing these procedures under local anesthesia , which allows us to monitor brain function throughout the surgical procedure and safely intervene if necessary.
Endovascular treatment consists of opening the narrowed part 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 and traumatic, especially for the carotids, it carries a greater risk of complications, mainly stroke during the operation, so it is applied in special cases (previous endarterectomy with restenosis, neck after radiotherapy, stenosis that continues intracranially).
Classic open endarterectomy is still the "gold standard" of surgical treatment.