Carotid artery occlusion


Our brain is one of the two most protected organs along with the heart. It is contained within a solid structure such as a skull. It is fed by a very sensitive system in terms of blood circulation. The distribution in the blood circulation is regulated by the blood circulation system of many organs in our body. The heart and brain, on the other hand, regulate their own needs. In other words, if it needs blood more, it adjusts and increases the blood flow. This is a very important insurance system. These veins form a system of circles and pools, called the circle of Willis (polygon). You can see this structure below. Cerebral blood circulation is provided by two veins at the front (carotid: carotid artery) and two veins at the nape (vertebral artery).

You can see the answer to the question of what is the jugular vein in the picture below. When there is a stenosis in these veins and blood flow decreases, other veins increase their own blood flow and fill the deficiency. In general, the veins that are in the foreground in atherosclerosis are the jugular veins. The most common cause of carotid artery occlusion is arteriosclerosis. We call this atherosclerosis. It is called atherosclerosis or calcification of the arteries. This disease is part of the general Cardiovascular Disease. Risk Factors: 1. Family Cardiovascular Disease 2. Family History of Stroke/Stroke 3. Diabetes 4. Hypertension 5. High Cholesterol 6. Obesity 7. Smoking 8. Sedentary Life 9. Excessive Alcohol Consumption How Cardiovascular Occlusion Occurs? Atherosclerosis or calcification that develops in the carotid artery occurs in a similar way as in other arteries. As a result of the accumulation of fats, cholesterol and calcium on the vessel wall, a lime layer (plaque) forms on the vessel wall.

• This plaque grows into the vessel, causing its diameter to narrow and blood flow to decrease. When the blood flow to the brain is below the need, what we call “ischemia” happens.

• In addition, the plaque that develops in the vein is not always hard, and soft lime pieces can go to the brain with blood circulation (embolism) and block certain areas.

• Clots formed in the vein can block the veins in a similar way. IT IS IMPORTANT TO DETERMINE PRE-DETERMINATION of stenosis in the jugular vein. Approximately 40% of stroke/stroke patients are caused by these carotid stenosis. I recommend people over the age of 65 to have Carotid Vein and abdominal ultrasound (for enlargement of the abdominal main vein) once a year. Both increase with age. I will explain this one more time. Rarely, vascular rupture (dissection), regional radiation therapy (radiotherapy) and some rare vascular diseases, which are more related to trauma, may cause stenosis in the carotid artery. Signs of carotid artery stenosis or occlusion

• The stenosis in the carotid artery may not give a clear indication until it reaches a critical level.

• Transient symptoms and complaints lasting less than 24 hours due to insufficient blood flow or small calcification/clot formation in the vein are called “Transient Ischemic Attack (TIA)”.

• These clots or pieces of lime give symptoms by clogging the vein or veins in accordance with its diameter. Complaints and symptoms; On the arm, leg, face or half of the body

Numbness, tingling

• Loss of strength

• Paralysis, slipped lip, deletion of traces

• Blurred vision and vision loss

• Speech difficulty/inability to speak

• Tongue limp, inability to order words

• Inability to understand spoken

• Dizziness and/or loss of balance

• Unconsciousness Transient ischemic attacks are considered “minor strokes” alarm bells. Some patients may even be unaware of this situation. The cases where the lip print is lost or the lip falls off can be detected by family members when they wake up in the morning. For this reason, after the age of 60 or in people with risk factors for atherosclerosis, examination for carotid artery occlusion should be performed. Let’s put one more note here. It should also be kept in mind that patients after the age of 60 may additionally enlarge the abdominal vessel (abdominal aortic aneurysm). After a certain age, simple ultrasonography examinations for both the jugular vein and the abdominal vein should be planned annually. How is the diagnosis of carotid artery stenosis/occlusion made?

• Doppler ultrasonography: It is the simplest examination. 20 min. is completed in.

• MR or CT angiography

• Angiography (DSA) tests are performed. Since carotid artery stenosis is included in Cardiovascular Diseases, these patients should definitely be examined in HEART VESSELS. In 15-20% of those who are found to have carotid artery stenosis, there may also be stenosis in the Cardiovascular Veins. Acting on this fact, patients can be evaluated together with Cardiovascular angiography, which takes a short time, together with Cardiac Angio. It is important to see all the vessels in order not to miss an important stenosis. The rate given above was found to be much higher at 77% in a recent publication. Sulženko J, Paluszek P, Machnik R, Widimský P, Jarkovský J, Pieniazek P. Prevalence and predictors of coronary artery disease in patients undergoing carotid artery stenting. Corona Artery Dis. 2019 May;30(3):204-210. What are the treatment methods of carotid artery stenosis?

• If the stenosis does not exceed 50%, drug treatment is sufficient.

•Control of risk factors; healthy eating, quitting smoking, controlling blood pressure, blood sugar and cholesterol levels. anticoagulant drugs; Aspirin and Plavix (clopidogrel) are the most commonly used.

•The most important criterion for the treatment is whether the Carotid Vein Occlusion Symptom or Not. This is an important criterion for treatment.

A mere symptom may not be enough. Diffusion MRI can detect some events that the patient does not feel. In this case, the patient is evaluated in the category that needs emergency treatment.

• SURGERY is considered when the stenosis is 70% or more. It has been scientifically proven that performing surgery reduces the likelihood of stroke. • There is roughly 3-5.8% risk of stroke per year, depending on the degree of occlusion of the Carotid Vein. Is there a risk of stroke in this procedure? Yes there is, but it is lower than the previous figures. It is about 2% level.

•Surgical (endarterectomy: removal of the calcified plaque) or alternative stenting method can be applied.

• Balloon Angioplasty is more preferred primarily in lower-grade carotid artery occlusions.

• Stenting is mostly applied in carotid artery occlusions with symptomatic stenosis rate of less than 70%.

• Mortality rate was found to be higher in stenting compared to surgery in carotid artery occlusions. It was found to be 3.6% in Stenting and 1.6% in Surgery. Today, there has been a decrease in the number of stents in European countries after 2012.

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Castro-Ferreira R, Freitas A, Sampaio SM, Dias PG, Mansilha A, Teixeira JF, Leite-Moreira A. Early results of carotid endarterectomy versus carotid stenting: Outcomes from a Mediterranean country. vascular. 2019.

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