Carotid artery

Carotid artery. Initially they are called common or primitive carotid arteries, and later they bifurcate in the so-called external carotid artery and internal carotid artery.

Summary

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  • 1 Types of carotid artery
    • 1 The External Carotid Artery
      • 1.1 Path
      • 1.2 Relationships
      • 1.3 Distribution
    • 2 The Internal Carotid Artery
      • 2.1 Path
      • 2.2 Carotid plexus
      • 2.3 Distribution
    • 2 Carotid artery disease
    • 3 What are the symptoms?
    • 4 Causes and risk factors
    • 5 Diagnosis
    • 6 Treatment methodology
    • 7 External links
    • 8 Sources

Carotid artery types

The internal carotid artery will supply the interior of the skull, while the external carotid will supply the head and neck.

The External Carotid Artery

Artery that arises from the bifurcation in the neck of the carotid and ascends to the retromandibular region where it divides into its two terminal branches: superficial temporal and internal maxillary.

Journey

It emerges from the carotid bifurcation (common carotid) at the upper edge of the thyroid cartilage, at the level of the fourth cervical vertebra (C4). It continues its journey and, after emitting 6 collateral branches, it divides into two terminal branches: the superficial temporal artery and the maxillary artery (or internal maxillary, or internal mandibular). Two parts are seen along the path of the external carotid artery:

  • First portion, also called the superior carotid region, which begins from its origin at the upper edge of the thyroid cartilage and extends to the transverse cross of the posterior belly of the digastric muscle in front of the artery.
  • Second portion, which starts from the posterior belly of the digastric muscle, crosses the stylous muscles, runs very close to the pharynx and penetrates a little into the parotid gland, where it is related (close to) to the internal jugular vein and the facial nerve. It ends up bifurcating into two terminal branches, at the posterior edge of the neck of the condyle of the mandible.

It branches into 6 collateral branches (superior thyroid artery, lingual artery, facial artery, occipital artery, posterior auricular artery, and inferior or ascending pharyngeal artery, and 2 terminals (superficial temporal artery and internal maxillary artery).

Relations

The external carotid artery is covered by the skin, the superficial fascia, the platysma muscle (traditionally musculocutaneous), the deep fascia, and the anterior margin of the sternocleidomastoid muscle; it crosses the hypoglossal nerve, with the lingual, ranina, common facial, and superior thyroid veins, as well as the digastric and stylohyoid muscles; higher it deepens towards the substance of the parotid gland, where it runs below the facial nerve and the junction of the maxillary and temporal veins. Medial to it are the hyoid bone, the pharyngeal wall, the superior laryngeal nerve, and a portion of the parotid gland. Lateral to it, at the bottom of its path, is the internal carotid artery. Subsequent to it, near its origin, is the superior laryngeal nerve; and higher,

Distribution

The external carotid irrigates the neck, face and skull

The Internal Carotid Artery

It is the second branch of the common carotid artery. They supply blood supply to the anterior portion of the brain. They originate, at the angle of the mandible, from the right common carotid arteries (which arises from the brachiocephalic trunk) and left (which arises directly from the aortic arch), which branch to form the internal and external carotid arteries. They ascend in front of the transverse processes of the 3 upper cervical vertebrae without branching into the neck. Inside the skull they are housed in the cavernous sinus, where it is close to the VI cranial nerve and crosses the dura, remaining in the subarachnoid space. It is divided into segments: cervical segment , petrosal segment , Segment acerum , Segment cavernosum, Segment clinoid , Ophthalmic Segment and Segment communicant

Journey

The internal carotid artery is a terminal branch of the common carotid artery. It begins approximately at the level of the third cervical vertebra, or at the upper edge of the thyroid cartilage, when the common carotid branches into this artery and the more superficial external carotid artery. From its origin at the upper edge of the thyroid cartilage (C4, or fourth cervical vertebra), the internal carotid ascends somewhat obliquely back to the superior carotid region, then it crosses the retrostyle space together with the vascular-nervous package of the neck (from that point upwards, said package is made up of the internal carotid, the internal jugular vein and the vagus nerve) and also together with the 9th, 11th, 12th cranial nerves, the jugular carotid chain ganglia, and the superior cervical ganglion of the cervical sympathetic chain; It penetrates the carotid duct (intrapetrosal portion) and describes two elbows here that carry it over the anterior torn hole in the cranial cavity. Inside the skull, it has an intradural path inside the cavernous sinus. It ends in the anterior clinoid process, dividing into four widely divergent terminal branches: the anterior cerebral artery, the middle cerebral artery, the posterior communicating artery, and the anterior choroidal artery. The anterior cerebral artery and the posterior communicating artery, together with the anterior communicating and the posterior cerebral, form the Willis Polygon. It ends in the anterior clinoid process, dividing into four widely divergent terminal branches: the anterior cerebral artery, the middle cerebral artery, the posterior communicating artery, and the anterior choroidal artery. The anterior cerebral artery and the posterior communicating artery, together with the anterior communicating and the posterior cerebral, form the Willis Polygon. It ends in the anterior clinoid process, dividing into four widely divergent terminal branches: the anterior cerebral artery, the middle cerebral artery, the posterior communicating artery, and the anterior choroidal artery. The anterior cerebral artery and the posterior communicating artery, together with the anterior communicating and the posterior cerebral, form the Willis Polygon.

Carotid plexus

The sympathetic trunk forms a plexus of nerves around the artery known as the carotid plexus. The internal carotid nerve arises from the superior cervical ganglion, and forms this plexus, which follows the internal carotid into the skull.

Distribution

The internal carotid is distributed to the middle ear, brain, pituitary gland, orbit, and choroid plexus.

Carotid artery disease

Carotid artery disease is the narrowing or blockage of the neck arteries that supply oxygen-rich blood to the brain. Carotid artery disease is the leading cause of stroke. This disease is a frequent problem and the main cause of stroke. Patients are at increased risk of developing carotid artery disease and stroke if they already have coronary artery arteriosclerotic heart disease or have a family history of heart disease or stroke. Carotid artery disease is caused by the same factors that contribute to coronary artery arteriosclerotic heart disease, but it tends to develop later in life. Fewer than one percent of adults in their 50s have significant narrowing of their carotid arteries. Yet 10 percent of adults in their 80s have extensive narrowing.

Atherosclerosis or (hardening of the arteries) cannot be completely prevented, but the progression of the disease or the risk of developing atherosclerosis can be reduced through changes in lifestyle and diet. The best preventive measures are to exercise regularly, eat a diet low in cholesterol and saturated fat, and maintain a healthy weight. A type of drug called statins can reduce the amount of cholesterol in the bloodstream and can limit the growth of plaque.

What are the symptoms?

Many people with carotid artery disease have no symptoms. Not everyone who has a stroke due to carotid artery disease previously experiences the warning sign called a transient ischemic attack (TIA). The patient has warning symptoms depending mainly on whether the surface of the plate has been softened or broken. Unfortunately, stroke is often the first symptom of carotid arteriosclerosis.

The classic symptoms of TIA due to carotid artery disease are:

  • Partial loss of vision in one eye;
  • Weakness, tingling, or numbness that occurs without apparent cause on one side of the body or in the arm or leg;
  • Temporary loss of control of movement in an arm or leg; or
  • Difficulty pronouncing words or speaking clearly.

These warning symptoms disappear on their own within minutes after they appear, leaving no residual effects. They should always be considered potentially serious and should be reported to the doctor immediately. They are also indicative of stroke if they last longer than a few hours.

Causes and risk factors

Atherosclerosis is the cause of carotid artery disease. With age, fatty deposits called atherosclerotic plaque build up within the walls of the arteries, causing them to narrow. This progressive disease process occurs to varying degrees in many of the body’s major arteries. Atherosclerosis is the basis of most arterial diseases, including carotid artery disease.

Factors that increase a person’s risk of carotid artery disease include:

  • Smoke;
  • High blood pressure
  • Diabetes
  • Male gender
  • Family history of atherosclerosis

Diagnosis

To diagnose carotid artery disease, the doctor will first obtain a detailed description of the patient’s symptoms. The doctor may use a stethoscope to listen to the carotid arteries on either side of the neck to detect a “buzz” or “hiss” caused by turbulence in the blood flow of the narrowed carotid artery. Measuring blood pressure in both arms is also an important part of evaluating carotid artery disease in order to detect possible narrowings in other branches of the blood vessels in the upper body.

Based on the results of the patient’s medical history and the findings of the physical examination, the doctor may indicate the following studies:

  • Duplex ultrasound of the carotid;
  • Transcranial Doppler ultrasound;
  • Computed tomography (CT);
  • Magnetic resonance angiography (MRA); or

Treatment methodology

The way to treat carotid artery disease depends on the patient’s symptoms, the condition of all the blood vessels that supply blood flow to the brain, and the degree of narrowing of the carotid artery. Not all cases of carotid artery disease require an interventional or surgical procedure to treat them. If the patient has been referred to a cardiovascular specialist, there is a likelihood of narrowing or stenosis of the carotid arteries. The disease is usually treated if there is evidence of a TIA and significant artery injury. Sometimes patients with a history of a previous stroke, who are still at risk for new strokes, are also treated. If carotid disease does not require direct treatment, Medication and lifestyle changes may be applied to try to limit plaque growth. Another important part of nonsurgical management is ensuring that the patient and close family members understand the warning signs of a TIA.

Invasive treatment methods include:

  • Carotid endarterectomy. Carotid endarterectomy is the most frequently used procedure to remove plaque from the inner lining of carotid arteries. The surgical procedure is the recommended and traditional treatment for carotid disease. The surgeon exposes the carotid artery through an incision in the neck. Sometimes, a small tube is inserted into the normal segment of the carotid artery below and above the narrowed segment to pass blood around the area of ​​the carotid artery to be cleared. In other cases, collateral blood flow from other arteries is sufficient so that deviation is not required. The carotid artery is then opened, and the liner and plaque it contains are carefully and precisely removed to leave a smooth, open artery. The artery is then stitched closed and the bypass tube, if used, is removed. Recovery is quick, and the patient can leave the hospital the day after the procedure.
  • Angioplasty and stent placement. Angioplasty and stenting are minimally invasive techniques that are performed under local anesthesia. Angioplasty involves passing a balloon-tipped catheter through an artery in the groin into the narrowed area of ​​the carotid artery. Inflating the balloon expands the artery, effectively opening it. Today, doctors also insert a stent, a tiny, steel-mesh tube, that serves as a support to keep the artery open, in almost 100 percent of carotid procedures.
  • Changes in lifestyle. As with many cardiovascular diseases, lifestyle factors can contribute to carotid artery disease. The first step the patient should take is to modify any behavior that increases the risk of carotid artery disease. Some of these changes should include:
  • Give up smoking;
  • Lose weight;
  • Exercise regularly;
  • Reduce cholesterol and saturated fat intake; or
  • Reduce alcohol consumption.

 

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