carotid stenosis

Carotid stenosis: description

Physicians refer to a narrowing (stenosis) of the carotid artery (carotid artery) as carotid stenosis. There is a right and a left common carotid artery, which run from the chest to the head on the sides of the neck. They divide approximately halfway up the neck into an internal and external carotid artery (internal carotid artery and external artery). The internal carotid artery (ACI) supplies the brain with blood, while the external carotid artery (ACE) primarily supplies the scalp and face.

Carotid stenosis: frequency

Everyone can develop a narrowed carotid artery. The incidence increases with the age of the patients: According to the guideline, 0.2 percent of men under the age of 50, but 7.5 percent of men over 80 years, have a carotid stenosis. Women under 50 are statistically not affected by a narrowing of the carotid artery, but 5 percent of those over 80 years old.

Carotid stenosis: symptoms

Carotid stenosis often causes no symptoms for a long time. Physicians then speak of asymptomatic carotid stenosis. If complaints occur, they can be different. Example:

• Vision disorders such as double vision or visual field loss
• speech disorders
• Paralysis on the arms and legs
• a headache
• vertigo

These carotid stenosis symptoms can be on a paroxysmal schedule and persist for minutes to hours. When they regress, it is also referred to as a Transient Ischemic Attack (TIA), a temporary lack of blood supply to the brain. If the symptoms persist for a long time, it is a stroke (Apoplex, Insult).

Carotid stenosis: causes and risk factors

The most common reason for carotid stenosis is vascular calcification (arteriosclerosis). In old age, high blood pressure and increased blood lipid levels, the blood vessels are gradually damaged, and it form deposits (plaques) on the vessel walls – including the carotid artery. The deposits can rupture, enter the bloodstream into brain vessels and narrow or block one of them. The consequence of this is a reduced blood flow to the brain tissue. If the downstream brain tissue is not quickly supplied with sufficient oxygen, it dies – an ischemic stroke (cerebral infarction) is present.

Carotid stenosis: risk factors

Various risk factors contribute to a narrowing of the carotid artery. These are above all:

• Age
• Hypertension (arterial hypertension)
• Diabetes mellitus (diabetes)
• Smoke

The lifestyle has accordingly a great influence on the development of carotid stenosis. Those who eat well, move well and do not smoke, are less likely to suffer from a carotid stenosis than someone who practices an unhealthy lifestyle.

Carotid stenosis: examinations and diagnosis

If your family doctor suspects that your carotid artery is narrowed, he will refer you to a neurologist. He can use targeted examinations to detect carotid stenosis. First, he asks you in detail about your medical history (anamnesis). Possible questions include:

• Do you suffer from high blood pressure or diabetes?
• Do you smoke?
• Do you suffer from blurred vision now and then?
• Have you had paralysis of arms or legs lately?

Carotid stenosis: physical examination

The doctor then examines you. He feels the pulse on his neck and wrists. If carotid artery stenosis is present in the portion of the common carotid artery, there may no longer be any palpable pulse or significantly less there than at the other sites. Then the doctor listens to your heart and your large vessels with the stethoscope. In carotid stenosis, flow sounds may be audible over the carotid arteries.

Carotid stenosis: laboratory tests

Your doctor will give you blood to check for blood lipids, sugar levels, and clotting levels in the lab.

Carotid stenosis: Apparative investigations

In particular, the ultrasound examination (sonography) is helpful in the diagnosis of carotid stenosis – more specifically, a special form of ultrasound: the duplex sonography. With their help, both the bloodstreams in the vessels and the vessels themselves can be displayed. This allows the severity of the stenosis to be determined and the type of constriction to be recognized. If the deposits on the vessel wall are rather firm and compact, the likelihood of their detachment is less than with brittle and uneven deposits.

In addition, an ultrasound examination of the heart can be performed. The doctor can determine whether clots have formed in the heart, which threaten to be washed into the carotid arteries and to lay these.

Furthermore, a long-term echocardiography (long-term ECG) is performed to find possible indications of cardiac arrhythmias. These increase the risk that clots form in the heart, which can move the carotid arteries.

In order to be able to visualize possible vasoconstriction in the brain, such as an ACI stenosis (narrowing of the internal carotid artery), a transcranial Doppler sonography can be performed. The flow velocities in the cerebral vessels are recorded with an ultrasound device.

Maybe an angiography will be done. In this vascular presentation, the patient is injected with contrast agent and the patient’s head is X-rayed. The blood vessels fill with contrast medium, which makes possible constrictions visible.

Carotid stenosis: treatment

The aim of treating carotid stenosis is to prevent a stroke and to ensure blood supply to the brain. For this it is important to first minimize the risk factors. As a patient, you can make a significant contribution: Get into a healthy lifestyle with sufficient exercise, a balanced diet and abstinence from nicotine. Furthermore, your blood pressure and blood sugar should be optimally adjusted. A healthy lifestyle also helps here. If necessary, the family doctor prescribes additional medication (antihypertensives, blood sugar lowering).

To reduce the risk of stroke, the doctor may also prescribe blood-thinning medicines. These so-called antiplatelet agents (such as acetylsalicylic acid = ASA) prevent blood clots (thrombi) from forming and clogging the vessels.

Carotid stenosis: surgical treatment

Surgery may be indicated in patients who have already had a stroke due to carotid stenosis or are at high risk of stroke (due to, for example, very severe vasoconstriction or very high blood lipid levels). In the so-called thromboendarterectomy (TEA), the stenosis is removed under general anesthesia or regional anesthesia: The surgeon exposes the affected area of ​​the carotid artery via a skin incision and cuts it open. He removes the deposits on the vessel wall and then sews the vessel again. The operation takes about an hour.

There is a risk of the operation itself causing a stroke. Therefore, the procedure should only be performed in medical centers that have sufficient experience with TEA. In addition, the benefits and risks of surgery must be carefully considered for each patient. A key factor in the decision for or against the intervention is life expectancy, the degree of the stenosis and possible pre-existing conditions. Patients who have a symptomatic constriction with a stenosis of more than 70 percent are often advised to undergo surgery.

Another method that is used in carotid stenosis is the so-called Carotid angioplasty, The affected vessel is expanded from the inside with a balloon catheter. Carotid angioplasty is mainly used when a narrowing occurs again after a TEA, or when a TEA is not possible due to particular anatomical conditions.

Carotid stenosis: disease course and prognosis

Carotid stenosis can go undetected for a long time and cause no symptoms. This is dangerous, as the narrowing of the carotid artery usually increases over time, increasing the risk of stroke. Every year, about 2 out of every 100 asymptomatic carotid stenosis discovered by chance trigger a stroke. In addition, patients with carotid stenosis have an increased risk of having a heart attack.

Accordingly, doctor and patient should talk extensively about treatment options. By changing the lifestyle with adequate exercise and healthy eating, the prognosis of carotid stenosis be improved.