Many patients have carotid disease without even knowing it, so artery examinations are recommended for 40-year-olds, especially if their parents died early from myocardial infarction.
Unfortunately, diseases of the heart and blood vessels are still the leading cause of death in many countries of the world, and carotid disease stands out among them. It occurs due to the narrowing of the blood vessels of the neck, due to which the brain receives less blood and oxygen than it needs, so the cells die and stroke occurs.
Cardiologist Dr. Predrag Radojkovic says that the data show that a stroke will affect six out of a hundred people at the age of 65, but that this disease can occur at any age. Although stroke is the first cause of disability and, unfortunately, the third cause of death, this gloomy statistic is changing and mortality is declining thanks to a number of prevention measures that prevent a fatal outcome.
Dr Predrag Radojković (Personal photo archive)
The risk is higher due to high pressure
The most important risk factors that reduce blood flow through the carotid arteries are high blood pressure, smoking, high levels of total cholesterol and triglycerides, and a decrease in good cholesterol. Diabetes, obesity, lack of physical activity, as well as the family history of the disease and the patient’s age also play an important role. Previous research has shown that the risk of early atherosclerosis is 2.7 times higher in women and 1.7 times higher in men whose parents died 55 years ago from myocardial infarction.
– Many patients have carotid disease without even knowing it. That is why prevention is important, which includes, in addition to the doctor’s examination, laboratory tests and examination of the blood vessels of the neck with a Doppler device. This examination is recommended after the age of forty, even in the absence of any symptoms, in order to gain insight into the patient’s condition – Dr. Radojković points out.
Blood vessel Doppler is one of the most important examinations in neurological patients, in addition to brain tissue imaging methods. The examination is painless, non-invasive, without harmful radiation and can be repeated. It is used in patients who have weakness and tingling in half of the body, loss of vision in the halves of the visual field, loss of sensation in half of the body, dizziness. This provides valuable information about the appearance of the blood vessels of the neck and the flow that can be measured. The so-called transcranial Doppler is a supplement to the previous examination and it is possible to measure the blood flow through the anterior, middle and posterior cerebral artery as well as through the arteries of the cervical-occipital basin. The conditions examined by this method are related to diseases of the blood vessels of the brain. All doubts and dilemmas, when necessary, are resolved by standard angiography,
However, the big problem remains ignorance, many are not aware that they have a problem and that they need help.
– The consequences of narrowed blood vessels in the neck can be great, because the brain requires a large amount of oxygen, even though it makes only two percent of the total body weight. As the most perfect organ, it requires a perfect blood supply and is very sensitive to the lack of oxygen and glucose in the blood. Complete cessation of blood flow leads to irreversible damage to brain cells in just a few minutes – our interlocutor warns.
When carotid disease is detected, the degree of risk due to the reduction of blood flow through this blood vessel is first assessed.
– If the degree of reduction of blood flow is less than 50 percent, the patient receives medication, when the reduction is between 50 and 70 percent, it is possible to treat with drugs, but also with surgical implantation of a stent. Surgery is necessary when the degree of narrowing is greater than 70 percent – says Dr. Radojković.
Prevention for all cardiovascular diseases is the same, so here too doctors remind how important it is to take care of healthy habits: maintain optimal body weight, regularly control blood pressure and blood sugar, be physically active. Exercises or activities that a healthy person or patient chooses should take place several times a week for 30 to 40 minutes.
What deceives patients is the lack of symptoms that would indicate that something is wrong. The stroke comes suddenly, and the consequences are permanent brain damage.
Research shows that by the time symptoms appear, the carotid artery is already clogged 70 percent. This is because only a small number of stroke patients are preceded by recognizable symptoms – deprivation of one half of the body or visual impairment. In most cases, the first and only manifestation of carotid artery disease is stroke.
– If a patient has a heart attack, his condition can be partially or even completely improved. But when a stroke is experienced, nothing can be fixed with any subsequent surgery, because it is about brain cells – experts point out.
Objective: to slow down the disease
What happens when narrowings are discovered?
– In patients who have changes in the arteries, but are not for surgery, it is important to slow down the development of stenosis, ie narrowing of blood vessels. If the blood vessel is completely blocked, nothing can be done about the carotid artery. In that case, the other artery is monitored and the narrowing is reacted in time. When the patient is aware of the problem, eliminates all risk factors and comes for regular check-ups, then his prognosis is quite good – says Dr. Radojković.
Transient and permanent damage
The main pathological changes in the vascular network of the brain are arteriosclerosis and atheromatosis. Arteriosclerosis is a degenerative process with changes in the inner layers of the walls of blood vessels, which leads to their narrowing. Atheromatosis is a limited, localized process of formation of deposits, ie plaque in certain places on the walls of blood vessels, which leads to a local narrowing of the affected blood vessel and a consequent reduction in blood flow. The consequences can be transient in the form of brain damage, permanent after a stroke, but also chronic in the form of vascular dementia. In a large number of cases, there are changes in the blood vessels of the brain, which do not give any clinical manifestations, so they are called asymptomatic by one name.
Classic surgery or stent implantation?
Classic surgery involves surgical access to the blood vessel through the front of the neck, opening the blood vessel itself, removing plaque, ie cleaning or cutting off the part of the blood vessel affected by the plaque and merging with the healthy part. The stent is implanted with a minimal surgical incision in the groin, and from there it reaches the artery in the neck through a microscopic fiber through a blood vessel. A stent is placed at the site of narrowing.
– Usually, classic surgery is preferred, and the stent is implanted in people who cannot receive total anesthesia due to heart disease or some other reason. The implantation of a stent is also a solution when the narrowing is on an inaccessible blood vessel or if the narrowing has occurred again after the classic operation – says Dr. Radojković.