Our brain, along with the heart, is one of the two most protected organs. 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 vessels and blood flow decreases, other vessels fill the deficiency by increasing their own blood flow. 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.
⦁ Family Cardiovascular Disease
⦁ Family history of stroke/stroke
⦁ High Cholesterol
⦁ Still Life
⦁ Excessive Alcohol Consumption
How Does Carotid Vein Occlusion Occur?
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, but soft lime pieces can go to the brain with the 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. 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 symptom 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 language
⦁ Dizziness and/or loss of balance
⦁ Loss of consciousness
Transient ischemic attacks are considered “minor strokes” as the alarm bell. Some patients may even be unaware of this situation. Situations 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. Based 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?
⦁ Control of risk factors; healthy eating, quitting smoking, controlling blood pressure, blood sugar and cholesterol levels.
⦁ The most important criterion for treatment is whether Carotid Artery Occlusion Gives Symptom or Not. This is an important criterion for treatment.
⦁ It may not be enough just to have a symptom. Some events that the patient does not feel can be detected by diffusion MR examination. In this case, the patient is evaluated in the category that needs emergency treatment.
⦁ SURGERY is considered when the stenosis is 70% or more.
⦁ Roughly, depending on the degree of occlusion of the Carotid Vein, there is a risk of having a stroke of 3-5.8% per year. 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.
⦁ Surgery (endarterectomy: removal of calcified plaque) or alternative stenting method can be applied.