Carotid artery stenosis causes, symptoms and surgical treatment

What is pathology?

Carotid artery stenosis (SNA) is a condition manifested by pathological narrowing (partial or complete) of the vascular lumen, which leads to a decrease in the blood supply to the brain. As a result, its cells receive less oxygen and nutrients - this is called ischemia. This prolonged deterioration in perfusion over time can cause encephalopathy. In the case of an acute blockage, a stroke occurs - the most severe consequence of this disease.

This is a very dangerous disease, since it has a large percentage of complications - in almost 2/3 of cases, discirculatory encephalopathy or acute cerebrovascular accident (stroke, stroke) occurs. It develops mainly in elderly men.

Classification by origin

Some vascular pathologies are considered the immediate causes of CA stricture:

• obliterating endarteryitis - an autoimmune-allergic disease that leads to a gradual narrowing of the lumen of the vessel up to its complete blockage due to the accumulation of immune complexes in its wall;
• atherosclerosis - the most common cause of narrowing, occurs against the background of impaired lipid metabolism and leads to the appearance of plaques that clog the vessel;
• nonspecific aortoarteritis (Takayasu's syndrome) - an autoimmune disease of mainly parts of the aorta, which leads to increased thrombus formation;
• congenital developmental anomalies;
• fibromuscular dysplasia is a systemic lesion of the vascular connective tissue, which is manifested by a lack of elastic fibers and increased proliferation of fibrous and muscle fibers.

According to the mechanism of development of ischemic changes, there are three main forms:

1. Hemodynamic - a decrease in blood flow due to vasoconstriction by more than 75%. It is the main cause of discirculatory encephalopathy.
2. Microembolic - separation of microthrombi from the altered vascular wall. Usually small vessels are blocked, causing transient attacks.
3. Thrombotic - the formation of large blood clots that completely block the lumen and lead to extensive strokes. The predominant localization is the place of bifurcation (bifurcation) of the common carotid artery into internal and external. It is considered the most dangerous form, often fatal.

Symptoms of the disease

Symptoms of stenosis of the carotid arteries are very nonspecific, most of them are found in other diseases. In accordance with the clinical features, 4 main forms can be distinguished, which manifest the narrowing of the carotid vessels:

1. Asymptomatic - despite the fact that the narrowing is present, the manifestations of cerebral ischemia are compensated. This option can only be discovered by chance, during surveys;
2. Dyscirculatory encephalopathy is a chronic pathology resulting from constant oxygen starvation of brain tissues. It is manifested by the following symptoms:
   • headache
   • dizziness, fainting
   • deterioration in sleep;
   • emotional lability
   • impaired coordination of movements
   • visual and hearing disorders
   • weakness, fatigue;
   • decreased memory, concentration of attention, speed of thinking;
   • difficulty speaking;
   • mental disorders;
   • eventually dementia (dementia) may develop.
3. Transient ischemic attack is a temporary disturbance of cerebral blood flow, which is manifested by focal neurological deficit, depending on the location of the lesion. All symptoms disappear within a day, more often within a few hours.
4. Acute disorders of cerebral circulation (stroke) - ischemia and necrosis of a part of the brain, which is manifested by symptoms of neurological deficit. Most often these are paresis of the muscles of the face, limbs, speech disorders, loss of consciousness.

If any signs of a narrowing of the SA appear, you should immediately consult a doctor, since the pathology tends to progress rapidly.

Operations for stenosis of the carotid artery

Treatment for stenosis of the carotid artery can be both conservative and surgical. The first option is acceptable only in the initial stages of pathology, as well as as a supportive therapy for secondary prevention. The most effective drug method for the autoimmune nature of the disease.

However, the only means that can effectively restore normal hemodynamics in the basin of this vessel and prevent critical complications is surgery.

Surgical intervention for stenosis of the carotid artery is carried out according to strict indications:

• the degree of obstruction is more than 70%, even in the absence of clinical manifestations;
• recurrent transient attacks with more than 50% occlusion;
• suffered a stroke associated with the pathology of the carotid arteries;
• lack of effect from drug methods.

Operations can be open or minimally invasive (endoscopic). Now they prefer to use the second option, as it is safer.

There are four main types of surgical intervention for narrowing of the SA:

1. Carotid endarterectomy is necessary to remove the embolus or atherosclerotic formations on the wall. This is an open operation in which a vessel is cut and a thrombus or plaque is mechanically removed. In some cases, complete removal of a portion of the artery is done.
2. Stenting is a minimally invasive procedure in which a special probe is inserted into an artery through a small incision in the skin. Approaching the site of occlusion, he first expands the lumen, and then installs the prosthesis in the form of a mesh tube. This is the most common and safest treatment. Conducted under X-ray control
3. Prosthetics - if a large area of ​​the vessel is damaged, it is removed, and then an artificial prosthesis is installed.
4. Reconstructive surgery - used to treat congenital developmental defects (usually abnormal tortuosity). For this, the most deformed section of the vessel is removed, and the remaining part is straightened and sutured.

Service efficiency and price

All of these operations effectively remove the obstruction to blood flow, and the patient may feel improvement almost immediately after recovering from anesthesia. However, it should be remembered that surgical intervention only affects the pathogenesis of the disease, and not its causes. Therefore, if the provoking factors of atherosclerosis (or other diseases leading to occlusion) are not eliminated, relapse is often possible. In addition, prostheses or stents can cause blood clots, and therefore the patient must constantly take antiplatelet drugs.

The prices for such operations vary greatly from clinic to clinic. Carotid endarterectomy costs from 30,000 rubles in a public hospital and from 100,000 in a private one. The cost of stenting is much higher - in the range of 50,000 - 200,000 rubles. In some cases, such interventions are carried out free of charge, under the compulsory medical insurance.

Basics of patient rehabilitation

Immediately after the surgery, the patient is placed in the intensive care unit, where he stays on bed rest under constant supervision for two to three days. After that, he is transferred to a regular ward and gradually increases physical activity. Abrupt movements should be avoided for another 2 weeks after discharge from the hospital so that the stitches do not come apart.

Over the next year, the patient must be observed by a cardiologist at least 2 times a year (preferably 1 time per quarter). He must also measure pressure daily, and if the indicators increase, consult a doctor as soon as possible.

Supportive therapy is also prescribed, which includes drugs that have antiplatelet, hypotensive and lipid-lowering effects. Its duration must be at least 5 years.

In order to prevent relapses and complications, it is necessary to adhere to the following recommendations:

• adhere to a low-calorie diet, give up flour and fatty foods, alcohol;
• exercise regularly. The degree of stress should be determined by the doctor;
• quit smoking;
• get more rest and walk in the fresh air.

Forecast

The duration and quality of life depends on the following factors:

• the degree of occlusion;
• strict adherence to medical prescriptions and preventive recommendations;
• timely surgical intervention;
• regular examinations.

If left untreated or improperly treated, the disease quickly leads to disability or death. So, with severe symptoms, the mortality rate will be about 40% during the first year. However, with the timely operation of the operation, the prognosis for life and working capacity is favorable.

Conclusions

Narrowing of the lumen of the carotid arteries is a dangerous disease that leads to disruption of the functioning of the brain and often ends in the development of dementia or death. The clinical symptoms are rather nonspecific, which complicates the diagnosis. Conservative treatment has a supportive nature; it is possible to get rid of the manifestations of pathology only with the help of surgical intervention. Also, for a full recovery, long-term rehabilitation and lifestyle correction are required.