Atherosclerosis of the brachiocephalic arteries (BCA) is a pathology associated with the presence of fatty plaques in the vessels that feed the neck and head. It ranks second in frequency after blockage of the coronary vessels supplying blood to the heart. Most often, the disease is recorded in elderly people suffering from severe hypertension and type 2 diabetes mellitus.
Pathology leads to stenosis and impaired blood circulation in the basin of the cerebral vessels. As a consequence, as atherosclerosis progresses, the risk of transient ischemic attacks and stroke increases.
Causes and typical patient complaints
The reasons for the development of atherosclerotic changes in BCA are:
- high blood flow rate in the vessels, which causes damage to the inner layer of the arteries by constant high pressure;
- a large number of branches;
- many obstacles to the laminar (calm, uniform) blood flow, which create branching, causing turbulence;
- violation of the concentration of low density lipoprotein (LDL);
- high blood glucose levels, which also damage the vessel wall.
Typical signs of the disease include:
- feeling of numbness in one of the halves of the body;
- weakness and fatigue;
- reduced working capacity;
- headache;
- chronic fatigue;
- violation of cognitive functions;
- memory loss;
- hearing impairment, vision.
Atherosclerosis of the brachiocephalic vessels never develops against the background of physical well-being and health. For the development of pathogenesis, provoking factors and background diseases are necessary:
- heredity;
- chronic and acute stress;
- smoking, alcohol abuse;
- addictive eating habits: eating fatty, salty foods low in fiber;
- limited motor regime, sedentary lifestyle;
- arterial hypertension;
- intrauterine anomalies in the development of blood vessels in the neck and head;
- male gender;
- menopause in women;
- age;
- overweight and obesity.
Disease classification
By localization of the pathological process:
- atherosclerosis of the extracranial (extracranial) parts of the BCA - the right and left common carotid arteries (CA) are of clinical importance;
- atherosclerosis of the intracranial parts of the BCA (right and left internal CA, which are part of the circle of Willis - the main vascular bed of the brain).
By the volume of lesion, atherosclerosis of the neck vessels is divided into:
- Non-stenosing - the pathological process covers less than half the diameter of the vascular wall. This type is more favorable, since the blood flow suffers to a lesser extent and the degree of cerebral hypoxia is insignificant. However, the chronic process does not stand still, expanding to the extent of the lesion.
- Stenosing chronic atherosclerosis of the brachiocephalic arteries - the vessel is occupied by a fatty formation more than half. At this scale, not only the volume of blood supplying the brain and head tissue decreases, but also the instability of the plaque increases, which potentially leads to its tearing with a subsequent thrombotic reaction. Such a situation would be fatal or could have serious health consequences.
Diagnostic measures
To make a diagnosis, your general practitioner or cardiologist will need to do:
- patient survey;
- examination of the patient;
- auscultation and percussion of the heart and lungs;
- laboratory blood tests - general clinical (blood + urine), the study of lipid composition (lipidogram), serum glucose;
- triplex scanning of brachiocephalic arteries;
- MRI of the brain (according to indications);
- BCA angiography.
Patient treatment and observation
Atherosclerosis of both extracranial and intracranial parts of the brachiocephalic arteries requires lifelong treatment, which includes pressure control, correction of blood cholesterol levels, and optimization of glucose metabolism in diabetic patients.
Modern possibilities of drug treatment are suitable for the therapy and control of non-stenotic atherosclerosis of the extracranial branches of the brachiocephalic arteries. For this purpose, appoint:
- Antiplatelet and anticoagulants ("Aspirin", "Clopidogrel", "Warfarin", "Xarelto"). The drugs improve the rheological characteristics of the blood, preventing thrombus formation. An important additional property of these medications is the widening of the lumen of the arteries, which facilitates blood flow.
- Medicines affecting cholesterol metabolism: statins and fibrates (Rosuvastatin, Simvastatin, Atorvastatin). They lower blood lipids, preventing the formation of new plaques.
- Antihypertensive drugs: ACE inhibitors, beta-blockers and other drugs that are included in the protocol for the treatment of hypertension ("Enalapril", "Perindopril", "Lisinopril"). When taken daily for long periods of time, they lower blood pressure levels to safe levels.
Nootropic drugs (those that supposedly improve the functioning of the brain), dietary supplements, homeopathy and herbal preparations have no proven effectiveness, only emptying the patient's wallet.
In addition to conservative management of the patient, there are interventional and surgical methods for correcting blood circulation that are applicable for stenosing atherosclerosis of the brachiocephalic arteries:
- Percutaneous (percutaneous) balloon angioplasty. The technique involves the introduction of a special catheter into the affected artery. Under X-ray control, thanks to a preparation containing iodine, it is possible to accurately determine the narrowing site and eliminate it by expanding with a balloon located at the end of the guide wire.
- Stenting. The procedure involves placing a metal frame inside the artery. The device is inserted under the control of an X-ray machine using a catheter. However, this method is also imperfect: over time, the stent becomes overgrown with tissue so much that a second operation may be required.
- Carotid atherectomy - removal of plaque and calcifications formed on it using a special device that "cuts" them. It is performed, like the previous methods, by intravascular access. After resection of atheroma, a stent is placed. This technology prevents restenosis (re-occlusion).
- Bypass surgery - reconstructive interventions, which are based on the creation of a blood flow path (shunt) bypassing its obstruction. At the moment, vessels made of synthetic materials, as well as autoimplants (own veins from other parts of the body) are used as raw materials for the "new" artery.
Surgery does not exclude the use of the aforementioned drugs. The duration of drug use varies from several years to lifelong. Such patients need to visit a doctor at least once every 6 months.
Due to the severity of the disease and the costly surgical treatment, it is important to timely preventionwhich includes the following lifestyle changes:
- to give up smoking;
- daily physical activity;
- revision of diet and addictions with restriction of salt and animal fats;
- maintaining optimal weight;
- blood pressure control.
Possible complications
Complications caused by BCA atherosclerosis are associated with hemodynamic disturbances in the vessels of the brain (interruptions in blood flow). The most severe of them are:
- transient ischemic attacks;
- transient visual impairment;
- vascular dementia (dementia);
- ischemic stroke of the brain.
Conclusions
Both stenosing and non-stenosing atherosclerosis of BCA have an unfavorable prognosis for health and life in the absence of adequate treatment. Even a slight increase in blood pressure, detected at a control examination, signals that it is time to start preventive measures aimed at preventing the development of atherosclerosis.
