CAROTID ARTERY Disease
Introduction
Carotid artery disease is one of the most important and most common causes of stroke. It occurs when the carotid arteries, which are the main arteries supplying blood to the brain, become narrowed or blocked. Damage to these blood vessels is caused by atherosclerotic plaque, an abnormal buildup made up of cholesterol, calcium, and fibrous tissue. These deposits obstruct the carotid arteries, preventing proper blood flow to the brain.
The blockage increases the risk of stroke. A stroke is a medical emergency that occurs when the blood supply to the brain is interrupted or severely reduced. A stroke deprives the brain of the oxygen it needs, causing brain cells to begin dying within minutes. Carotid artery disease develops slowly.
The timely early diagnosis of the disease
is very important
for the good outcome of the condition in both stages of the disease.
What Is Carotid Artery Disease?
The severity of the stenosis determines the management. According to the guidelines of the European Society for Vascular Surgery (ESVS, edition 2023), surgery is indicated in symptomatic stenosis of 50% to 99%, while in asymptomatic patients it is considered from 60% με 70% and above, in centres with a low perioperative risk.
The main cause of carotid disease is the formation of atherosclerotic plaque or arteriosclerosis (thickening of the wall) in the common and internal carotid artery. This artery lies below the patient's jaw and runs from the aorta to the brain.
Carotid artery stenosis does not produce indirect symptoms that would lead to diagnosis. The only symptom carotid artery stenosis may cause is a direct stroke, either transient (TIA) or permanent.
The most common risk factors are hypercholesterolemia high blood cholesterol arterial hypertension high blood pressure diabetes, and smoking. A less common risk factor is radiation exposure to the area due to cancer of the organs of the neck. Since carotid artery disease can lead to the complication of stroke, early diagnosis and treatment are vital.
What are the interventional methods of surgical treatment?
Carotid Artery Disease: Treatment
The degree of narrowing of the lumen as an absolute number, for example 60%, is not a criterion for determining the severity of the disease or the need for intervention. The main criteria that guide the decision on whether carotid artery disease should be treated are the following:
Presence of symptoms and stenosis > 50%
Flow velocities through the stenosis > 250 cm/sec (>70% stenosis)
3. Composition of the atherosclerotic plaque (presence of thrombus, "soft" or "hard" atherosclerotic plaque).
In cases of carotid disease, immediate initiation of antiplatelet therapy should be undertaken, along with cardiological evaluation for the presence of coronary heart disease and administration of statins to lower cholesterol. If the disease meets the criteria recommended by the guidelines of the European Society for Vascular Surgery for surgical treatment, the most appropriate therapy between classic surgical repair and endovascular stenting should be discussed with the vascular surgeon. As a general rule and based on the results of large randomized studies, open surgical repair is recommended in symptomatic patients and in patients with asymptomatic stenosis without a particularly burdened cardiac history. Endovascular stenting is recommended in patients with a particularly burdened cardiovascular profile where anaesthesia is not indicated, as well as in patients who have been previously operated on the carotid or have been irradiated in the area. With the Hybrid Operating Room the treatment of carotid disease is achieved bloodlessly and without complications.
Contact our clinic for personalized diagnosis and treatment.
The role of the vascular surgeon
The role of the Vascular surgeon in the treatment of carotid disease is decisive for the evaluation of imaging methods (carotid triplex, computed tomography, magnetic resonance imaging), as well as the decision for the most appropriate treatment (endarterectomy, stent, medical therapy). For more information Get in Contact with the Vascular Surgeon, Dr. Theodosis Bisdas
