July 14, 2023

2023-07-13 16:59:36

Carotid artery disease in the neck

* Is surgery necessary to treat cervical artery stenosis?

– This is a summary of your questions regarding the doctor’s diagnosis of severe stenosis in one of the main neck arteries, and your previous stroke a few months ago, and its effects have gone away from you. However, the doctor suggested surgery to address this problem.

Note the following points in sequence:

• A diagnosis of carotid artery disease means that there are fatty deposits narrowing or blocking this important artery that carries blood to the head and brain. Having this narrowing increases the odds of having a stroke (symptoms lasting more than 24 hours) or a transient ischemic attack (symptoms that go away in less than 24 hours). A stroke means that all or most of the blood supply stops reaching the brain or parts of it. Thus, the brain will not get oxygen, and brain cells will begin to die within minutes. A transient ischemic attack is a temporary decrease in blood flow to the brain. This is why knowing and treating the causes of stroke is so important.

• Carotid artery disease often occurs gradually. The early stages of carotid artery disease usually have no symptoms, and the condition often progresses to a point where the narrowing is severe enough to block blood supply to the brain, causing symptoms of a stroke or transient ischemic attack.

Their symptoms include sudden numbness or weakness in the face or one part of the body, on one side of the body, or a sudden disturbance in the ability to speak and understand speech, or a sudden problem with vision in one eye or both eyes, or dizziness and loss of balance. Or a severe and sudden attack of headache. And if the person feels, or those around him notice that on him, it is worth going to the ambulance department urgently.

• The main pathogenetic mechanism of carotid artery disease is the buildup of fatty deposits – called plaques – in the arteries that carry blood from the heart to the brain. These deposits contain a mixture of clumps of cholesterol, fat and types of blood cells. This process is called “atherosclerosis”. What motivates the occurrence of these pathological changes in the components of the walls of the arteries of the neck is either the presence of high blood pressure, or diabetes, or smoking, or high levels of light cholesterol and triglycerides, in addition to obesity, advanced age, or sleep apnea. or lack of physical exercise.

• Clinical examination using a stethoscope, may show a murmur or noise over the site of the carotid artery in the neck. And the occurrence of this sound is due to blood flow through the narrowed area in the artery. Then the doctor resorts to ultrasound imaging, to assess the extent of blood flow, the amount of pressure in the carotid arteries, the degree of narrowing in them (percentage of the amount of narrowing), and other information. Sometimes a CT or MRI scan of the brain and arteries (often with dye) is done to assess whether the brain has any previous strokes (even if the person has not felt them before), or other problems in the brain or blood vessels within the brain. These scans also provide more information regarding blood flow in the carotid arteries and other nearby arteries.

• The presence of these narrowings (according to the percentage of their severity) in the carotid arteries in the neck, making it difficult for oxygen and nutrients to reach the brain. This may be evident in stroke. Specifically, between 10 and 15 percent of patients with these severe stenosis may have a stroke.

This occurs according to 3 possible scenarios: the first is the result of the development of severe carotid artery stenosis that prevents sufficient blood from reaching parts of the brain. The second is the fragmentation of part of those masses that are deposited in the walls of the arteries in the neck, and they are thrown into the cerebral arteries, and they get trapped in one of the arteries, which prevents blood flow from those smaller arteries inside the brain, and thus stops the blood from reaching one of the parts of the brain. And third, that the blood fluid itself may coagulate locally (coagulate to turn into a cohesive mass) on the surface of those wall accumulations inside the neck arteries, then that blood clot travels from that area to one of the brain arteries itself, which may cause it to be blocked, and thus a stroke occurs. Therefore, the increase in the size of these fatty accumulations, and the narrowing of the neck arteries, causes stroke through several possible mechanisms.

• In addition to following prevention steps (stopping smoking, controlling blood pressure levels, controlling cholesterol levels, controlling blood sugar, exercising, reducing weight, etc.), and in addition to the possibility that the doctor suggests taking medications that prevent blood clot formation, he may see The doctor states that it is necessary to conduct a radical treatment of these narrowings in the arteries of the neck, in order to expand the blood flow through them first, and to prevent the possibility of repercussions secondly, especially if there is severe narrowing in the carotid artery (i.e. it reaches between 70 and 90 percent), or You have already had a stroke or transient ischemic attack.

• One of the possible radical treatment methods is surgery to remove the carotid endarter, ie in which there are those large fatty accumulations (carotid endarterectomy). The other method is to perform a carotid angioplasty, to widen the narrowing through a catheter and by inserting a balloon, then installing a stent in the place of the expansion. That is, similar to what is done to treat narrowing of the coronary heart arteries. And medical advice depends on using one of the two methods, but each of them has reasons that you prefer over the other. That is, in some cases, surgery may be recommended as a first line of treatment, while in other cases dilatation and stent placement may be recommended as a first line of treatment.

• According to a review of many medical sources, the preference for any of the two methods of treatment depends on several factors, in the case of the arteries, the brain, the general health condition of the patient, and other factors he has, as well as the availability of treatment capabilities and medical experience in providing treatment.

To be clear, carotid endarterectomy is the most common treatment for severe cases of carotid artery disease that have caused cerebral symptoms (stroke). It is performed either under local or general anesthesia. During this procedure, the surgeon makes an incision across the front of the neck, opening the carotid artery and removing the masses blocking the artery. The surgeon then repairs the artery with stitches or a graft made from a vein or synthetic material. Surgery is often recommended.

Carotid angioplasty and stenting are preferred for blockages that are difficult to reach with carotid endarterectomy, or for people who have other conditions that make surgery too risky. However, several other factors remain with the patient, others with the doctor, and the availability of capabilities, which make the doctor who follows directly the patient’s condition the best in providing a proposal for the method of treatment, without another, to treat the condition of the patient himself.

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