What is carotid artery stenosis?
Carotid stenosis is a narrowing of the carotid lumen due to atheromatous plaque in the carotid artery, mostly in the bifurcation of the common carotid artery and the beginning of the internal carotid artery. Some stenotic lesions may even progress to complete occlusive lesions.
What are the risks of carotid artery stenosis?
Ischemic stroke is a common risk of disability, and carotid stenotic lesions are very closely related to ischemic stroke. The general causes include.
1. reduced cerebral perfusion due to severe stenosis.
2, cerebral infarction caused by dislodgement of atheromatous plaques in the carotid arteries or dislodgement of microthrombi formed by plaque rupture.
The latter cause is especially more common. The main symptoms caused by carotid stenosis are transient dizziness, blackness in front of the eyes, transient weakness of one limb, and even the serious consequence of permanent hemiparesis. Therefore, carotid stenosis should be treated actively.
How should carotid artery stenosis be treated?
First of all, carotid artery stenosis should be given high priority and risk factors should be actively controlled, and antiplatelet therapy is beneficial. For patients with carotid artery stenosis of 50% or more with clinical symptoms, or patients with stenosis of 70% or more, surgical treatment should be actively undertaken. Aggressive surgical treatment is effective in reducing the incidence of stroke and hemiparesis events.
What are the surgical treatments for carotid stenosis?
Surgical treatment of carotid stenosis is basically divided into 2 types.
1.Carotid endarterectomy, which is a classic surgical procedure, widely carried out at home and abroad, with definite surgical results.
2, carotid artery stent implantation, which is a minimally invasive treatment method widely carried out in recent years, with the aim of achieving a cure through stent implantation, with little trauma and quick recovery.
Vascular surgery has accumulated rich experience in both carotid endothelial stripping and carotid stent implantation, and has solved the disease for a large number of patients.
What are the possible symptoms of carotid artery disease?
Carotid artery disease can be asymptomatic in its early stages. Unfortunately, patients with carotid artery disease can have a stroke without any warning. Some patients may experience some precursory symptoms called transient ischemic attacks (TIAs), or “mini-strokes,” beforehand. Symptoms can last from a few minutes to several hours and include.
1. weakness, numbness or tremor in one limb.
2. lack of movement in the limb l difficulty seeing out of one eye (many people describe this as feeling like a dark shadow in front of their eyes).
3. slurred speech.
Most of the above symptoms disappear within 24 hours. However, you should not ignore it. This transient ischemic attack indicates that you may have a serious stroke in the near future. You should seek immediate medical attention when these symptoms occur.
How should I be examined for carotid artery disease?
When you are seen, your doctor will first ask you about your general condition, including your medical history and symptoms, such as whether you smoke and have a history of high blood pressure, when your symptoms occur and how often they occur.
In addition, the doctor will perform a physical examination, including auscultation of the carotid arteries with a stethoscope, and may hear a vascular murmur if there is carotid stenosis. Ultrasound Probe After taking a history and examining you, if your doctor has a high suspicion that you have carotid artery disease, he will recommend a carotid ultrasound. This is a painless test in which the doctor holds an ultrasound probe to examine the carotid arteries to see the rate of blood flow and blood flow. This test will give your doctor a general idea of whether your carotid arteries are narrowed or occluded. Most carotid artery disease can be detected by carotid ultrasound, but if the ultrasound does not provide enough information, your doctor may perform the following tests.
Carotid CTA: This is carotid artery enhancement CT + 3D reconstruction. It can clearly show the specific shape of the carotid artery and intracranial vessels, and visualize the stenosis site.
MRA: This is carotid enhancement MRI. MRI uses radio waves and a magnetic field to create specific images that can show the form of blood flow and help evaluate the carotid arteries. For the accuracy of the test, doctors sometimes inject a contrast agent containing gadolinium.
Stenosis arteriogram: In this test, the doctor obtains images by injecting a contrast agent directly into the artery. This allows visualization of the location and extent of the arterial stenosis. However, arteriography is an invasive test and carries certain risks, including a very low probability of stroke. For this reason, it is not generally used as the test of choice by physicians, except in the case of direct imaging prior to preparation for carotid stenting.
What is carotid endarterectomy?
Carotid endarterectomy is the earliest, safest, and most effective method of treating carotid artery disease. Surgery may be required if the carotid artery disease is severe or has progressed from previous cases. Severe disease manifestations include a previous history of transient ischemic attack and cerebral infarction. When severe carotid stenosis exceeds 70%, surgical treatment is indicated even if asymptomatic.
What patients are candidates for carotid endarterectomy?
Carotid endarterectomy is indicated if you have severe carotid stenosis, especially if you have a history of transient ischemic attacks and are in relatively good physical condition.
What are the conditions that may increase the risk of carotid endarterectomy?
There is a risk if the following conditions exist.
1. severe cerebral infarction that has not fully recovered.
2. Patients with malignant tumors with an expected survival time of less than 2 years.
3, severe hypertension, which is not formally controlled on weekdays.
4, unstable angina pectoris.
5, history of cardiovascular accident within 6 months.
6, congestive heart failure.
7, progressive brain lesions, such as Alzheimer’s disease.
How is carotid endarterectomy performed?
Carotid endarterectomy in our vascular surgery department is usually performed under local anesthesia (carotid plexus anesthesia), but of course it can also be performed under general anesthesia. After successful anesthesia, an incision will be made in your neck to expose the carotid artery so that it can be blocked and opened. Once the carotid artery is exposed, a plastic tube (carotid diverter) will be inserted at both ends of the blocked carotid artery to ensure blood flow to the brain while stripping the sclerotic plaque. Once the sclerotic plaque has been stripped, the arterial wall is sutured, the diverter tube is withdrawn, the block is released, and hemostasis is performed, usually with a special polyester patch, to avoid future restenosis. Finally, the skin is sutured and a drainage tube is placed in the wound before suturing to facilitate drainage of the residual blood around the artery.
What should I expect after my carotid endarterectomy?
Once you are awake from the anesthesia, you will be taken back to your room and given fluids and medication to keep your blood pressure stable. You will be able to drink water and eat a small amount of fluid 1 to 2 hours after surgery. There is usually only mild pain after the procedure, but you can ask for pain medication if the pain is unbearable. You may feel discomfort in your throat. You may try to get out of bed the day after the surgery. If there are no special circumstances, we will not give you intravenous fluids. You can have your wound stitches removed 5-7 days after surgery, and you can check out of the hospital afterwards.
How to treat after having carotid artery disease
The treatment depends mainly on the severity of the disease. Specifically, it depends on the presence or absence of symptoms caused by carotid artery disease and the general condition of your body. But first your doctor may recommend medication and lifestyle changes. If you have other medical conditions, it is important to follow your doctor’s recommendations. For example, if you have diabetes, be sure to monitor and control your blood sugar regularly; if you have high blood pressure, be sure to take antihypertensive medication to control your blood pressure as recommended by your doctor; if you have hyperlipidemia, be sure to monitor your blood lipids regularly and take lipid-lowering medication as recommended by your internist. If you are a smoker, be sure to quit smoking. In addition, you can take a small amount of aspirin daily to reduce the viscosity of your blood.
What is the choice between the two surgical procedures (carotid endarterectomy and carotid stenting)?
Which of the two procedures (carotid endarterectomy or carotid stenting) should I choose? What are the risks of each procedure? The decision of which procedure to choose is made by an experienced vascular surgeon based on the patient’s specific situation.
Carotid endarterectomy: This is a surgical procedure to remove the plaque and thrombus from the carotid artery. This is a more traditional surgical method and the technology is more mature. The patient can return to normal life 1-2 days after surgery. The main and serious surgical complication of carotid endarterectomy is stroke attack, but the incidence is low, usually less than 2%. This is followed by peripheral nerve injury and cardiac accidents. Also, with the presence of atherosclerotic disease, carotid artery stenosis can occur again after surgery. In addition, because anticoagulation therapy is required after surgery, there is a possibility of wound bleeding and hematoma.
2.Carotid artery stenting: This is a more promising alternative therapy to carotid endarterectomy, which only requires a femoral artery puncture under local anesthesia or mild general anesthesia to implant a metal stent into the narrowed carotid artery to support the stenosis and serve the purpose of making blood flow smooth. It avoids the complications such as cranial nerve damage and hematoma compression caused by the surgical incision in the neck. Because it is less invasive and has a faster recovery, it can still be considered for patients who are too old or too ill to tolerate carotid endarterectomy. In addition, restenosis after carotid endarterectomy, carotid stenosis near the skull base that makes the procedure more difficult, and carotid lesions caused by radiation are good indications for stent implantation. However, carotid artery stenting also has its disadvantages: it is more expensive; it is also associated with stroke, hemiparesis and even life threatening; in some cases, carotid artery stenosis is too severe or completely occluded for the delivery device to pass, in which case endarterectomy is the only option. In addition, it also has the same problems such as restenosis.
Carotid artery lesion treatment options.
The carotid artery is the main artery supplying the brain. Poor access to the carotid artery, blockage or constant shedding of emboli into the brain will produce insufficient blood supply to the human brain, TIA attacks, loss of vision and even blindness, and when the carotid channel is completely blocked, stroke and hemiplegia can also occur, with serious consequences. Carotid artery lesions include carotid stenosis, carotid malformation, carotid aneurysm, arteritis, etc. The most common is carotid stenosis, the common cause of which is atherosclerosis, and the treatment has evolved from drugs to surgery (endothelial stripping) and to intracavitary intervention.
No generalizations can be made, but must be both principled and individualized. There is no one method that can cover all the bases, i.e., replace another method.
Carotid Endarterectomy (CEA) has been performed by Eastcott for 50 years since 1954 and is still an important tool in the treatment of occlusive atherosclerosis.
The indications for CEA are: carotid stenosis is asymptomatic in at least 80% and symptomatic in at least 50%, but it is difficult in the following cases.
1, previous CEA has been performed
2, congestive heart failure
3, severe coronary artery disease
4, previously treated with radical neck treatment or radiation therapy
5, COPD, chronic obstructive pulmonary disease
6, contralateral carotid artery obstruction
7, Age >80 years
Roubin has been using CAS (Carotid Artery Stenting) for 10 years now. There was no difference between the two groups in terms of stroke and mortality CEA cranial nerve palsy and hemorrhage were more frequent than CEA, and cranial nerve injury (0%Vs5.3%,P